The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Changing the forces through the joint => Topic started by: aturpin on December 09, 2008, 09:06:47 PM

Title: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 09, 2008, 09:06:47 PM
I recently had a distal femoral osteotomy performed on my left femur and wanted to share my experience for the benefit of any of you out there who might find yourselves in my shoes.  I found these message boards very helpful, but also very scary when I was researching my procedure and learning of others' experiences.  I found the color commentary and anecdotal stories of others' experiences to be worrisome so the purpose of my posts will be to offer a straightforward day by day account of what happened to me.  I also found it very difficult to find a person who matched my particular circumstance (i.e. age, activity level, degree of deformity, lifestyle, etc.) so perhaps I can offer the experience of a different segment of the population that hasn't been offered yet.

History:  I am 27 years of age, 5'9", female, 140 lbs.  I have arthritis in my left lateral compartment of my knee and also have a 12 degree valgus deformity.

Procedure:  Distal Femoral Osteotomy;  I had a lateral opening wedge with a bone graft from my iliac crest (hip).  Basically, the Dr sawed through part of my femur and jacked it open about 10mm (enough to correct the deformity and straighten the leg), he then took 3 bone plugs from my hip bone to fill the whole which accelerates healing and helps the bone fill in the gap.  The grafts and the gap are secured with a plate and a few screws.

I have led a very active lifestyle and competed in the heptathlon in college at a Division I school. During my competitive days I tore my ACL throwing the javelin.  I had it reconstructed and continued to compete for the next 4 years. it wasn't  until I was playing basketball just over a year ago (March 2007) that I was having a problems with the knee. In sum, I landed funny on my knee and sheared off some of the articular cartilage on the lateral condyle of my femur.  While I was originally a little knock kneed, the missing cartilage and continued wear worsened my condition and the knock kneed-ness.  My doctor recommended a femoral osteotomy in order to stave off a knee replacement (because I am too young for this procedure) and to preserve my existing cartilage.  We are also planning on an allograft cartilage transplant once I have rehabbed from this surgery.  Having the correct alignment is key to the success of the next procedure as well.

I underwent my distal femoral osteotomy on Dec. 6th, 2008 at Scripps Green Hospital in San Diego, Ca.  My doctor is William Bugbee and he is well published and very experienced with this procedure. The following account is my experience.  All in all, this surgery was not nearly as bad as it sounds or as I thought it would be.... at least for me.  It is absolutely true when they say that "everyone is different and everyones experience is different."

Post-Op Day 1:  I was given a femoral block which numbed my entire left leg during surgery. Because of the block, I did not need to be that deep under anesthesia and, therefore, I came out of anesthesia quickly and pretty pain free.  The surgery took about 90 mins and the time in recovery was about an hour. The remainder of the day I spent watching TV, eating (I had no problem eating with the anesthesia), and chatting with my roommate and visitors. i stayed in the hospital for 2 nights and left on the morning of the 8th. I slept well that night with the exception of my roommate who was elderly and got up every couple of hours to use the restroom. Also, the nurses come in to give pain meds and take vitals every 3 hours. I was able to keep the pain at about a 2 on a scale of 1 to 10 throughout the day.

Post-Op Day 2: The femoral block began wearing off around mid-morning but the pain never crept above a 3.  I was given Perkoset to control the pain and the only side effect I felt was sleepiness. I was fitted for a brace that I am to wear 24/7 and keep unlocked.  I was encouraged to begin range of motion exercises and to practice crutching around.  I was also instructed that I am to be only 30lbs. weightbearing which is akin to touching a toe down.  This is a nice relief though, to be able to put a foot down.  It takes some pressure off the hands and you don't get tired as quickly when crutching. I will be 30lbs. weightbearing for a minimum of 6 weeks. I had a physical therapist come visit me today and take me through range of motion exercises and crutching around.  There wasn't much pain associated with the PT and I was able to get around well.  I was also able to lift my leg unassisted which is very nice for moving around. I slept well through the night and was woken up once for vitals and pain meds.

Post-Op Day 3:  I got to leave the hospital today and go home.  My dad is taking me home to Simi Valley, approximately 2.5 hours north of San Diego.  He drives an SUV so I rode home in the back of the car lying flat. Aside from some bumps the ride was relatively pain free.  I took a Perkoset before I left and napped part of the way.  My dad is taking me home to help me out for 2-3 weeks where I will be off of work focusing on rehab and resting. I am trying to wean myself off of the pain medications and my pain has climbed to about a 4.  Before bed I took a Perkoset and got my best night of sleep yet. I woke up once to try and get more comfortable as I prefer to sleep on my side rather than my back. My knee is pretty swolen and ice helps a lot. I am happy the surgery is over with and now I am on the way to recovery.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 10, 2008, 01:11:01 AM
Post-Op Day 4 (Dec. 9th):† The hospital arranged for at home physical therapy for me and they came to visit today.† We worked on range of motion and leg lifts.† At this point I am able to get about 40-50 degrees of flexion and can do a few leg lifts.† The pain is concentrated mostly in the side of my leg where the cut through the iliotibial band to get to the bone.† A lot of my pain is in my hip where they took the bone grafts.† I was warned of this and it hasn't been too limiting, just more annoying than anything. It hurts to lay on directly and bites a little bit when I try to sit up or turn.† In addition to the leg lifts and flexion, I am also doing quad sets (flexing and releasing the quad).† The swelling has caused my quad to be less active so the flexing helps wake it up.† I also took my first shower in 3 days today... it felt great.† However, showering with one leg is tough.† I would highly recommend a stool to sit on and a hand held shower head so you can reduce the amount of standing and moving around. I have lowered my pain medication and am down to one pain pill in the day and one at night. I find the pain tolerable but still uncomfortable.† I am still ve ry swollen within the knee joint and the lower part of the quad.† My incision is a solid 4-5 inches and will probably leave a pretty good scar.† I also have a 3 inch incision on my hip that will probably leave a decent scar as well.†

Also, if anyone has any questions please feel free to contact me, I hope I can provide all of the information anyone needs to make this decision and make they're way through this procedure.  As a point of reference for anyone who had an ACL reconstruction,  I have found the pain and mobility to be very similar to what I experienced after that procedure.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 11, 2008, 01:12:57 AM
Post-Op Day 5 (Dec. 10th) - Last night was a difficult night of sleep as I attempted to cut out the pain medication all together.  I took an anti-inflammatory in the middle of the night and slept fine through the rest of the night.  Today I continued with physical therapy and practiced crutching around.  I continued with straight leg raises, range of motion and quad sets 4 times a day.  I am working to get to 90 degrees of flexion by the end of the week.  The pain associated with straight leg raises, quad sets and range of motion is pretty intense and I am looking forward to getting further along in the healing process.  This is certainly a lesson in patience and hard work. My swelling has gone down a tad today which is nice to see and I can bend further today than I could yesterday.  The progress in encouraging.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 12, 2008, 01:18:15 AM
Post-Op Day 6 (Dec. 11th) - My knee was pretty sore last night after doing extensive physical therapy throughout the day.  With the help of pain medication  I had a very good night of sleep, however.  The swelling in my knee seems to be at is lowest in the morning and each day is a little less swollen than the last.  Today I continued with physical therapy with 6 exercises (quad sets, heel slides, straight leg lifts, leg dangle, leg extensions, partial quad extensions) four times a day.  I can see definite progress in my flexion, pain and strength today as I have gained about 5 - 10 degrees of flexion and had less pain with leg lifts and quad extensions. I am also experiencing far less hip pain from where my bone graft was taken.  My overall daily pain level was also lower today than yesterday.  So far I am pleased with my progress and am staying positive and working hard.  No sense it dwelling in any pain or frustration.  My in home physical therapist is coming again tomorrow.  My goal is to show significant progress from her visit a couple of days ago.  Although the therapy is painful, the knee responds really well to it and the benefits definitely outweigh the pain.... that, and its necessary for proper healing.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 13, 2008, 06:16:07 AM
Post-Op Day 7 (Dec. 12th) - Today is the completion of my first post-op week and I am glad to have put it behind me.  The surgery was definitely the easiest part.  The hardest part has been range of motion and pain control....they kind of go hand in hand.  My in home physical therapist came again today and gave me some twists on the exercises I have been doing.  Most of the exercises are aimed at regaining flexion.  My goal is to be at 90 degrees flexion by two weeks at the very longest.  Desiring to over achieve, I am aiming for Tuesday of next week.  It is motivating for me to set real goals.  Today was a bit of a speed bump.  I was feeling more significant pain than usual so I went easy on the PT today. I am also experiencing a new pain today.  I am having pretty sharp and significant pain on my medial joint line.  It feels as though all of my weight was unloaded from my lateral side to my medial side (when it actuality the weight is distributed even across the joint).  I think this is made worse by all of the muscles and tendons which are confused and are adjusting to new angles and a new joint.  My lateral ligaments and muscles are all stretched out and my medial muscles and ligaments aren't bearing as much of the load as they used to.  If any of you out there reading this have had this surgery I would love to know if you have experienced this and, if so, how long did it last?  The pain is pretty sharp and it feels like the little weight I am bearing will cause the knee to give out a bit.

So, all in all, the first week has been challenging but I am proud that I have made it through and made good progress in my recovery. I am heading to outpatient physical therapy next week.  As far as resuming a normal life, I am having a hard time standing for longer than 5 minutes as the blood rushes to my knee and I can feel it swelling up and getting achy. I was able to sit at a restaurant today and I was able to walk/crutch through the parking lot to get there.  That't about all I can manage for now.  I am hoping to visit the gym this weekend (assisted of course and for upper body exercises only) and to make it through a movie at the movies in a week or so.  We'll see......
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 15, 2008, 08:02:52 PM
Post-Op Day 8 (Dec. 13th) - No real changes to report on Day 8. I am continuing with physical therapy and am getting close and closer to 90 degrees of flexion. I am having far less pain with the straight leg raises and some of the other more difficult strength exercises.  This could be a result of taking yesterday a little easy.  I was having some increased stiffness and achiness so I went easy on the PT.  I think the easier day did my leg well. The swelling is continuing to go down as well and I am getting some very good nights of sleep waking up only once or twice during the night to change positions.  I am sleeping with my knee brace as well, it hasn't been a problem though.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 15, 2008, 08:16:26 PM
Post-Op Day 9 (Dec. 14th) - I went to the gym for the first time today (assisted, of course).  I rode the stationary bike with one leg (propped the bum leg up on an exercise ball) for 10 minutes and did the hand bike for 10 minutes. I also did some abdominal exercises, only one of which was inhibited by my hip where they took the bone grafts were taken from, and some upper body lifting where my friend brought me the weights from the racks. It was really nice to get a good sweat going, however, it is amazing how much fitness you can lose so quickly by being idol and taking pain medications.  My knee held up pretty well through the hopping and moving around. I didn't put any weight on the leg but it did get jostled around a bit. I am continuing with the aforementioned PT exercises for the knee itself and have gotten to 90 degrees in some positions. Also, when experiencing discomfort it helps to lightly massage the quad and IT band.  I am also trying to stretch my IT band out
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 16, 2008, 05:24:54 AM
Post-Op Day 10 (Dec. 15th) - My range of motion continues to improve and my pain has also been decreasing each day.  Tomorrow I have my first day of outpatient physical therapy (where I go to them).  I am looking forward to getting another opinion on my progress but I am not looking forward to the pain I anticipate from new exercises and for a longer time. I was able to go to the gym today again and this time I drove myself there. This was my first time driving  post-op and I am lucky I had my left leg done instead of my right. I did the hand bike, PT and ab exercises and it felt nice to get in a good sweat.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 17, 2008, 05:27:58 AM
Post-Op Day 11 (Dec. 16th) - I slept terribly last night as I forgot to take my pain medication before bed.  I woke up in the middle of the night, took it, and slept well.  It appears that although I don't require pain medication during the day, I do need it to sleep. I have kicked the Perkoset all together (I think my last pill was 4-5 days ago) and am taking Ultram which is an anti-inflammatory with some Tylenol I believe. There doesn't seem to be any side effects particularly compared to the Perkoset. I am also taking Advil throughout the day to help with the swelling.

I went to my first day of outpatient PT today and it went really well.  I got my ROM officially measured and I got 95 degrees of flexion and am 3 degrees away from getting the same extension as my right leg. My therapist continued to work on my range of motion and brought to light one significant exercise that I hadn't been doing for my range of motion. He put me on my stomach and bent my leg up to try and get my heel to my butt (incredibly painful, btw, but temporary). I had significantly less flexion this way than I did with heel slides.  He measured the diameter of my quad, calf and knee and, to no surprise, I have had some pretty decent atrophy in my quad and am still carrying swelling.  We also did Russion Stem where he hooked me up to the E-Stem machine which causes your quad to contract involuntarily. When the machine made my quad contract, I flexed my quad.  This retrains the quad to fire properly.  We also did short arc quads while attached to the Stem machine.  I am glad to be able to get a hold of this equipment and feel good about my progress.  I go back again tomorrow for more work.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 18, 2008, 05:47:32 AM
Post-Op Day 12 (Dec. 17th) - I had my second outpatient PT session today and continued to make good progress.  I was able to get 118 degrees of flexion today and got to ride the recumbent bike.  I went very slowly (35 rpm's) but was nice to be able to make it all the way around. I was also able to get 10 solid straight leg raises with minimal pain.  My knee remains pretty swollen and is still achy.  I am icing as often as possible (5-7 times per day) and trying to stay horizontal.  If I stand for too long my leg aches and the knee swells.  My steri-strips are beginning to come off and I will begin with the Vitamin E and scar management once they come off. I am on my own for PT tomorrow and then have my third session on Friday.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 19, 2008, 05:06:55 AM
Post-Op Day 13 (Dec. 18th) - I am beginning to feel a lot better in activities of daily living.  I am able to sit in a chair through a whole meal without a ton of discomfort, I am able to hop around without feeling pain from the jostling, sleep is coming easier, walking (allbeit w/ 30% weightbearing) is getting easier.  The pain I mentioned on my medial joint line earlier has gotten much better as well. I feel like the better my range of motion gets, the easier life gets.  I think time has a little to do with it too. Coming up on the completion of my second post-op week I am pleased with my progress.  I am hoping to see some greater strength gains and less swelling in my third week. So far so good!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 20, 2008, 02:03:48 AM
Post-Op Day 14 (Dec. 19th) - Yay!  Today is my two week anniversary.  I celebrated by going to physical therapy. Things are going well there and I have gotten very good range of motion; 120 degrees.  That said, I am still partial weight bearing for 4 more weeks so it doesn't make a lot of sense to keep pushing it...aside from the fact that life is easier and I get less pain when I move around. I am going to try and get some more strength but there is only so much you can get from straight legs raises and quad sets. Nevertheless, I will try and get all the strength I can. For those worried about the pain of the surgery, the majority of the pain has dissipated now and I am able to get around pretty well. The first week was the toughest but if you have good company and people to help, it is definitely manageable.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 21, 2008, 07:08:47 AM
Post-Op Day 15 (Dec. 20) - I attempted to sleep without any pain medication last night (I have been taking Ultram before bed and Advil throughout the day).  I wish I could report a restful night but I can say that I had a much better night last night than I did the last time I tried to forgo pain medication. I woke up often in mild discomfort and just had a hard time getting comfortable.  I will go another week or so before attempting this again. Today was my first day on my own in my own apartment; up until this point I had been staying with my family at their house.  My apartment is upstairs but I had no problem getting up them, taking a shower (tub shower) or getting around.  It is comforting to know that I am capable of living independently now.  Things like tidying up, feeding myself and laudry are a bit challenging but not impossible by any means.  I carried on with PT and am about 10 degrees away from full flexion.  I am about 3-4 degrees from full extension (actually hyperextension which is my normal extension). Also, the medial joint pain I talked about earlier has gone away now and I am walking/crutching normally without problem.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 22, 2008, 06:35:38 AM
Post-Op Day 16 (Dec. 21) - I did a fair amount of driving today and was able to get around independently and pain free. I am capable of doing most things I want with the exception of walking. I am still carrying some swelling in my knee but am able to stand for longer periods of time without any throbbing or blood rushes. I am continuing with outpatient physical therapy and am continuing to work for more strength gains.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: cat on December 22, 2008, 01:22:04 PM
Sounds like you are doing well. Keep up the good work and thanx for sharing. I know some folks will be acutely interested in your progress.
 ;D cat† ;D

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on December 24, 2008, 06:09:32 AM
I'm def. interested. I've been reading every night.  I'm having a Femoral Osteotomy in April to de-rotate and straighten my right femur. Then maybe 4-6 months later do the left leg. I was pretty excited to hear that you're doing so well!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 25, 2008, 10:32:03 PM
Sorry for the gap in progress reports for those of you who are interested; the holidays get hectic.  And, thanks Cat.  I read a lot of your postings before my surgery and really appreciated the information you gave... just wanted to pay it forward.

Post-Op Day 17 (Dec. 22) - I had physical therapy today and we are progressing nicely.  I was able to get on the recumbent bike for fifteen minutes at level 4 and averaged about 70 RPMs.  I was able to get a good sweat going but really did notice the weakness in my surgery leg. I wasn't able to exert very much force.  That said, it felt like a good muscle building exercise. My range of motion continues to improve and I am at about 130 degrees. As I get more and more motion, the progress is a little slower.  In the beginning I could expect to make gains of 10-20 degrees in a week, now I am looking at 5-10 degrees each week. I am going to the gym regularly now and am able to get pretty good workouts.  I typically do the hand bike for 25 minutes, abs and upperbody. I don't have any pain hopping around anymore either. I am still trying to get off my nighttime pain med.  I tried again last night but wasn't able to get comfortable enough to sleep through the night. 

Post-Op Day 18 (Dec. 23) - I was able to go shopping yesterday and go the movies and out to dinner. I was happy that I could sit relatively comfortably through a movie and dinner and that I could stand long enough to go shopping.  I did have a scary incident though. I put my crutch on a sweater that had fallen off the rack by mistake. My crutch slipped out form under me and I put full weight on my leg.  It didn't hurt though, it just scared me. I shopped for about 2.5 hours and my leg tolerated it pretty well. However, my right leg was pretty tired from carrying all of my weight the whole time. I decided to take only half a pain pill before bed last night and it worked pretty well. I woke up once or twice but slept pretty well overall.

Post-Op Day 19 (Dec. 24) - As I approach my three week post-op anniversary I am going to post less as my progress is slower and restricted by my OS post-op guidelines.... basically, there is less to report. I had PT again today.  My insurance allows for 12 visits per calendar year so I am trying to get them all in. This is my 7th session, 5th outpatient session. The exercises remain the same from the beginning but I am adding 2-4 lb ankle weights to my short arc quad exercises and straight leg raises. I am also doing hip adduction and abduction.  I have seen a significant amount of atrophy in my left butt-cheek too so I am adding donkey kicks and leg lifts that will target my glute.  Today I was able to step up the resistance on the bike to level 5 and was able to get a good sweat going for 15 minutes.  Slept on half a pain pill last night but it didn't work as well as it did the night before last.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 30, 2008, 06:57:56 AM
Hi jumpi5d.  I am glad that my diary has been of use to you.  If there is anything you are especially interested in or anything I haven't mentioned please ask.  All in all, I have to say that the surgery itself is not bad.  The hardest part of this experience has probably been the first week post-op. The pain never got too intense but I definitely experienced a long ache for the entire week and I had a difficult time getting comfortable.  Also, the first steps in PT are tough.... breaking through the scar tissue and swelling brings on a lot of pain during the exercise and a lot of frustration at how far you have to go to get back to normal. After the first week, things definitely began improving. My best advice to prepare for this procedure is to be in as best shape as you possibly can, I truly believe this helped me come out of the surgery as well as I did, and to lay low for the first week.  By lay low I mean make as many arrangements as you can to be taken care of (i.e. meals prepared for you, having things brought to you, do all of your errands, cleaning, grocery shopping, etc. before surgery).  Lastly, stay on top of your PT no matter how painful at first, it definitely gets easier and the sooner you can get your flexion back, the easier and more comfortable life will be.

Post-Op Days 22-23 (Dec. 27th & 28th) - I spent the weekend on my own again and it went very well. I am getting help carrying things from the car to my apartment but was able to prepare breakfast unassisted and run errands. Right now the only thing I really can't do very well, aside from walk of course, is carry things due to the crutches. I find myself doing a lot of one legged hopping as to free up my hands and I have definitely noticed my calf and quad on my good leg getting stronger and fatiguing. I have no problem driving especially since I had surgery on my left leg but I think if it was my right leg I would be good enough to drive as well. I have been continuing with half pain pills before bed and its going well. I was bad and did not do therapy over the weekend, however, I finally got fed up and removed my steri-strips (I think 3 weeks is enough time).  My scar is going to be a bit difficult as there is a significant amount of scar tissue underneath it and its fairly raised and swollen still. That said, I am positive about the outlook for my scar in the long term as the actual incision is fairly thin.  Once the redness, swelling and raised part goes away it shouldn't be so bad.... i hope :).

Post-Op Day 24 (Dec. 29th) -  I had PT today and was able to get to 143 degrees of flexion. I am no more than 10 degrees away from touching my heel to my butt... my next goal.  I am at 4 degrees hyper extension also... this is good for me but most people shouldnt strive for hyper extension. My exercises remain consistent although I have progressed to the 4-way hip machine (same as the one at the gym) instead of using ankle weights. I continue with Russian stem and I think this is probably the best exercise I do there.  It allows my quad to really fire, more than I can do on my own. I am able to do straight leg raises with a 4 lb weight now and am happy with my progress although I do wish I was able to build up my quad more.  It is still very squishy and small. I see my OS on the 8th of January and I would like to have a good amount of muscle when I see him... i think it will help my case for walking at six weeks. I have PT tomorrow and the following day and then not for a while so I am hoping to get some advice and exercises that will sustain me for a couple of weeks.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 01, 2009, 05:42:36 AM
Post-Op Day 26 (Dec. 31st) - Today was my last scheduled day of PT. I am going to be leaving my dad's house where I have been staying since surgery and heading back to Orange County where I live. I expect to come back to physical therapy but it will probably be a couple of weeks.  Today was a milestone day in that today I touched my heel to my butt.  Yes folks, I got 100% of my flexion back.  Its not quite that easy though.  It was pretty painful and takes a couple seconds of good stretching to get there.  BUT, I have gotten there and each time will get easier and easier. Also, I am officially off of drugs.  I have been for a few days but wanted to make sure it was for good before I announced it.  Up until this week I was having a hard time sleeping without a mild painkiller/anti-inflammatory.  Now, I am sleeping fine on my own. Today I road the bike for a total of 30 minutes and 7 miles (not all at once, one time at PT and once at the gym).  It is psychologically and physically uplifting for me to go to the gym and get a good sweat.  I am also doing upper body weights and I think in some way this has all been helping my progress.  Each day I continue to make good progress and am enjoying the challenge of recovery. I see my OS next Thursday and am really looking forward to showing him my progress and getting his opinion. I am starting to get antsy to walk now and am trying to be patient.... I am not a very patient person for the record. I have had a couple of slip-ups where I have accidentally put full weight on my leg.  It hasn't been painful but I can definitely feel the weakness in my leg.  I am eager to get walking and get stronger but I will continue to be compliant and definitely isn't worth stunting my progress.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 03, 2009, 05:01:33 AM
Post-Op Day 28 (Jan. 2) - Happy New Year and Happy Anniversary to me.  I am officially at one month post op with two more weeks until I can walk...I hope.  I have been able to sustain full flexion and got my heel to my butt both yesterday and today. Yesterday it was still tough to get to but today it was a little bit easier. I am hoping this trend will continue. My OS told me I was allowed to bear 30% of my body weight so I have progressed to the leg press.  I have been doing single leg calf raises and the leg press with a single leg with 25 lbs. It isn't much resistance but enough to get my quad and calf working. I have been sleeping with my brace on still but am contemplating taking it off during the night. I am going back to my apartment to live full time tomorrow.  I am a little apprehensive about this since I have established a strong routine at my dad's house and I will also be responsible for all of my meals, getting to the gym (which is further than my current gym), laundry, etc. without help. Fortunately, I will only be doing this for a couple of weeks until I can walk. I also feel up for it as I am getting around pretty well and have become pretty resourceful. Monday the 5th was supposed to be my first day back to work but I was laid off during my leave from work so I will be spending this time looking for a new job.  I look forward to being able to walk so I can go interview and be able to work full time. Unfortunately, I will not be able to speak to the difficulties of getting to and from work after this procedure though I suspect that the biggest problem would be that everything takes longer to do with respect to getting to work in the morning.  Also, sitting in a chair for 8 hours would become uncomfortable in not too short of a time.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 05, 2009, 07:55:42 PM
Post-Op Day 31 (Jan. 5th) - No big news to report, everything seems to be moving along relatively slowly now. I am continuing physical therapy on my own and am still able to get full flexion and extension in the leg. I find my knee is pretty stiff these days and the area around my scar is a bit tender. These are proving to be annoying at the most.  I am looking forward to having a normal leg again where it moves freely and without stiffness. I am growing tired of the crutches as well.  At this point I find myself in a rut I suppose.  There isn't much more I can be doing on the physical therapy front and I have a week and a half until I can walk so I am just waiting now.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on January 07, 2009, 06:19:54 AM
I'm excited for you about how good you're doing. I've been reading, I don't really have any questions right now. I may later on though as mine gets closer. 

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 09, 2009, 02:19:06 AM
Post-Op Day 34 (Jan. 8th) - Today was my first followup visit with my doctor in San Diego. We took some xrays and it was crazy to see all of the hardware in my knee; I have 2 screws from my ACL reconstruction and the plate and screws from this surgery.  My bone is  healing really nicely and I can barely see where the opening wedge is.  If the bone isnt healing, it will show up grey or black on the xray, I had some nice white areas with a little outline of the wedge visible particularly at the smallest part; it is as if it fills in from the outside in. My OS was very happy and surprised with my flexion and extension. He also was happy with the way my scar is healing and told me everything looked really good. 

Now for the catch:  I have to stay on crutches for 4 more weeks. I cannot believe I have to be on these things for another month. My doc initially said 6 more weeks on crutches but I talked him down to 4 weeks until my next visit and if I look good he will let me go.  It doesn't make a lot of sense to argue with a guy who knows what the appropriate procedure is but I wanted to make sure he wasn't being too conservative. I know this surgery takes a really long time to heal and it is so important that this heals properly (its the biggest bone in the body afterall) but this is taking forever. I knew that people typically spend 8-12 weeks on crutches after this procedure but I heard 6 weeks and held on to it. In reality, his recommendation will put me at 9 weeks on crutches, totally normal. However, as the person on crutches, thats a long time. The good news is that I can switch to just one crutch and I can bear 50% of my weight now... this is progress, I realize. I also get to ditch my brace which is cool too.

As far as therapy goes, I think my biggest obstacle right now is scar tissue. The next toughest thing is to build up my quad muscle... this is especially hard to do on only 30% - 50% weight bearing.  Cycling is the best way to go about this right now.  I remember when I first had the surgery I could wait for 2-3 weeks to go by knowing that things would be better and get easier.  I am kind of in the same mentality right now.... I cant wait for the next 4 weeks to go by so I can resume my normal life and get some more mobility. I also am looking forward to getting the next 2 weeks under my belt where I expect to have more strength, less achiness and to have worked through some of the scar tissue.

So far, if I have anything to say about this surgery is that it is a commitment.  A commitment to put your normal life on hold for a couple of months and take care of something that needs to be done.  And, a commitment to follow protocol and behave despite ones desire to push it. Don't worry about pain, dont worry about discomfort from crutches, rehab takes care of itself if you are diligent, the biggest thing about this surgery is the inconvenience and the commitment. I have little doubt that I will look back at this and say that it wasn't worth it but only time will tell.  Till then I will keep up the hard work and keep on keeping on.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 09, 2009, 07:18:04 AM
I think I mis-spoke, or rather mis-typed.... to be clear, I am confident that the inconvenience and struggle will be worth it in the long run and I can't wait to be recovered and back on the mountains.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on January 09, 2009, 06:49:19 PM
I have been reading through since you posted and you have given me a little hope. I am having my op on Thursday and not currently sleeping at night. The thought of the pain after is really scary. Im sure it will be nothing like I imagine but its the thought of the unknown if that makes sense. Any advice you would pass on for my last few days before I give up normality for a few months?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 12, 2009, 10:51:51 PM
Hi Chereb,

I completely know what you mean about not sleeping.  I was having trouble sleeping and having nightmares about a week before the operation.  And, the worst part was not knowing what exactly to expect... that made it so much worse....the nervousness and apprehension brought me to tears many a night.  That is why I decided to do this post.  Before the surgery I wanted all the information I could get my hands on hoping that it would help cure my anxiety.  For some reason though, it didn't really work. Every bad thing I read made me more nervous and even though I told myself that my case would be different, there was still that lingering idea that it might not be and not knowing was torture. After all was said and done and I was out of surgery I looked back and thought that all of the fear and anxiety was so disproportionate to the actual outcome. 

I can't say you shouldn't be nervous because 1) I think that's impossible, and 2) you are going to have a big operation and no one really wants to do that. And, I can't tell you that your case will be just like mine because nobody knows. So, my best advice is to be positive, work hard at rehab and do everything you can to make post-op life as easy as possible. 

-Do all your laundry before surgery.
-Cook a bunch of meals before surgery and freeze them for easy prep post-op.
-Do your grocery shopping and clean house before surgery.
-Let someone help you for at least the first two week minimum but two weeks is better...any help after that is a great blessing
-One thing that is sooo helpful is having a wheelchair.  This doesn't have to be a wheelchair as much as just a chair w wheels. Something you can sit on and wheel yourself around in that will free up your hands for carrying things... even on carpet it will help but definitely for the kitchen and bathroom.
-I cannot tell you how much one legged hopping I am doing on my good leg (sometimes crutches are a hassle to just too slow). Get your good leg strong and ready to bear all of your weight for the next month.
-I have been taking a multi-vitamin everyday and am trying to eat a lot of protein, non-fat milk, and fruits and vegetables.... no useless carbs or sugars.  I really think this helps the body power up and helps the healing process.
-Be positive and be ready, willing and motivated to do rehab...its gonna suck in the beginning (1st week or so) but it will make everything easier and will help healing.
-Do rehab in an outpatient facility.  The camaraderie and opportunity to see people in your shoes is medicine for the mind. Even if they aren't as bad off it is therapeutic to see others struggling and working hard and it gets you out of the house.
-Lastly, go to the gym. Be as active (without risking your leg) as you can.  Do the hand bike, lift weights, whatever.  It gets the blood flowing and keeps your spirits and your health up. 

You said it best when you said you would be giving up normality for the next few months... that's exactly what it feels like.  I can do everything now that I could before surgery (except running, walking, etc...the obvious) but it takes longer and is twice the hassle. Just knowing this and being willing to be patient and accept it is half the battle. I'd say the last thing to worry about is the pain (provided you have decent nurses this will be under control). The hardest thing has been the rehab.  None of it is anything you can't get through.

I could go on and on (I think I have over the past 5 weeks :) ) but you will have your own unique experience and as long as you go into it with a tough mental attitude, a motivated spirit and a positive outlook you will be just fine.  Hundreds if not thousands of people go through this every week and we all make it out fine... and the majority of us are better for it. I won't sugarcoat it, it gets tough sometimes and frustrating and you may have a pity party or two but just be strong and this will pass.  Really, try not to be nervous.  If you are imagining anything like I was imagining, it won't be nearly as bad as you think. 

Good luck to you and if you have any questions or need any help please reach out, I am happy to help anyway I can.  Also, keep me/us posted on how you are doing. Don't worry, you are going to be great!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 12, 2009, 11:05:56 PM
Post-Op Day 38 (Jan. 12th) - I have been on 1 crutch for the past 4 days and I have to admit that scaling back to just one crutch makes life a lot easier.  I was disappointed with the news that I couldn't walk thinking how much it would suck to be on crutches for 4 more weeks.  But, one crutch for four more weeks is manageable.  Don't get me wrong, I would rather be walking but one crutch is a good compromise.

News:  Not a lot.  I am still hitting the gym and doing the therapy.  I can't help but feel a little stagnant as the leg can't heal fast enough  and I want to be doing more. I am just being patient, that is a key word in this whole thing, and doing the most I can for it. I don't think I have mentioned this so far, probably cuz it isn't that big of a deal, but maybe its worth bringing up.  So where my quad has atrophied has become quite tender...both the skin and the muscle.  I have been calling it veal for lack of a better explanation.  It just feels fragile and tender and unused and when I rub it too hard or scratch it, it hurts pretty quickly. Also, my hip flexors and quad is also very tight and sore.  It feels so good to stretch it, very much like a sore muscle from working out too hard or something.  The doctor thought this was pretty normal considering what was done to the hip and leg but it sure has been lingering for a while.

I went grocery shopping the other day which was nice because it was a step back into some normalcy... granted I did it on one crutch with the support of the grocery cart also.  But still, progress. I also have done laundry and cleaned the apartment a little... oh, and I can also vacuum and cook.  There really isn't anything I can't do now that I was doing in my pre-op life, it just takes longer and is a bigger hassle.

I am up to 45 minutes on the bicycle and felt my quad burning the other day... what a nice feeling after it has been dormant for so long. I am also doing the leg press but am keeping the weight to 30 lbs... frankly, Im not sure if I could do much more anyway. I can definitely feel the quad getting strong and being more alive and active. I have been working my calf also and it is improving but I have to say that my calf is tiny.... long way to go on that guy. My work is cut out for me but I am up for the challenge and can't wait to get back to my pre-op form.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on January 13, 2009, 03:16:54 PM
Thank you for the reply. Cant beleive its only 2 days away now. My left knee is shot too so dont know how it will go with being the main support. I have got a grocery shop sorted and DH is having 2 weeks off from work to help. Good idea on the wheelchair. My MIL has one which im sure i could borrow. I am trying to arrange the physio locally as the hospital is about 30 miles from me! I have spoken to my GP who said its not a problem so just have to get the hospital to make my referral there. You sound like you are doing really well and im sure it wont be long until you can finally walk. Once DH returns to work I have the 9 and 4 year old to take to school/nursery every day. Its only 5 minutes walk away but im sure it will be a challenge. Still having trouble sleeping....gets worse and im sure Wednesday night will be a sleepless one. At least I get a sleep on Thursday,lol. Trying to be positive and optimistic and its hard because you dont know for some time how successful its going to be! Once sufficiently recovered I will be having the left knee done too. Im sure I will wish I was still ignorant to knowing what the op is like for that one,lol

Take care of yourself...4 weeks will go past and you can dich the crutches hopefully! Good luck.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 16, 2009, 12:48:44 AM
Post-Op Day 41 (Jan. 15) - Over the last few days I have continued therapy and experienced a little push back from my leg.  On Monday I spent 30 minutes on the bike, did the leg press and 4 way hip machine and felt a little sore afterward and into the next day.  My knee was tight and achy.  I didn't feel like I really had done that much so I ignored the symptoms and did the same therapy on Tuesday.  I continued to feel tight and achy afterward and the following morning my knee was very swollen and my quad got a little sleepy.  I iced the whole day and did not do any rehab.  That seemed to help and I got back on the bike on Wednesday and Thursday without problems.  I know now what the symptoms of "overdoing" it are and will listen better next time.

On a side note, my knee is starting to look more and more like a knee each day.  This might not make sense but up until this point my leg looked puffy and disproportionate.  It now has definition where the knee joint is and appears to be settling into its new angle.

Also, today I forgot that I cannot walk and tried to take a walk to my bathroom from the bed. I put full weight on the leg as a normal step and the leg gave out.  I dont know what to think of this. I have been curious what it would be like to try and walk but didnt have the guts or willingness to disobey. But, now that it has accidentally happen I am glad to have found out.  However, I am dissapointed that the leg is still not ready to walk on.  It felt like it lacked the strength to support my body weight so I will continue to work hard to get my strength back and I will be patient over the next 3 weeks on one crutch.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 16, 2009, 12:55:03 AM
Hi Chereb,

Today was your surgery and I hope everything went really well.  Now you can relax and all of the anxiety and nervousness can did it!  And now it is time for healing.  I hope you are excited that you have the surgery over with and you are on the path to recovery. After the next 7 or so days you should be feeling a lot better so just hang in there, be patient and take it easy.  Take care of yourself!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 20, 2009, 07:25:21 AM
Post-Op Day 45 (Jan. 19th) - I am six weeks and a couple of days post-op and a little more than 3 weeks from my next appointment with my OS where I hope he will tell me that I can walk.  I am getting along well on one crutch and am trying to work on my gait so that when I am allowed to walk my limp will be minimal.  I have had a few instances where I have put full weight on my leg by accident and it is feeling more and more stable.  My quad is also doing well and continues to grow slowly.  I am continuing with the leg press and have moved my weight up to 35 lbs. I feel much stronger and more comfortable going through this exercise. My scar is looking good and is less and less raised but is still purple-ish and looks pretty intense. I am definitely hopeful for a small scar over time given how thin it is now.  I am continuing to try and eat as healthfully as possible and take a multi-vitamin with hopes that it could help my bone heal... couldn't hurt right?  I am almost as excited to walk as I am to see an xray of a fully healed bone.  Three weeks and two days and counting. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: tem8 on January 23, 2009, 09:08:21 PM
Hi aturpin,

I just wanted to chime in on this topic as I seem to be following a similar path to your own.  I had a distal femoral opening wedge osteotomy done on 12/12/2008 on my right femur along with a chilectomy on my right big toe.  My arthritis was similar - on the lateral side.  However, instead of a bone graft from my hip, I was given a wedge of cadaver bone.  My instructions were no weight bearing for 6 weeks (maybe because of the toe?).  I just hit the 6 week mark yesterday and the opening wedge appeared well healed. I was cleared to start weight bearing with a protected gait using both crutches.  There isn't so much pain, but my knee appears to be swelling in response.  I have tried 100% weight bearing a little bit and my leg was not ready. It is clear that at 6 weeks full recovery is still several weeks off. 

It is interesting to hear your account, especially how different doctors approach the recovery.  My doctor wants me off crutches within the week, though after my first full day weight bearing I am unsure that will happen (possibly because I have not been as aggresive with the PT as you).

As for flexion and extension, I am at about 110 degrees flexion after 6 weeks without doing too much PT. Been struggling a bit with the extension - the best I could get to so far has been about 4 degrees.  This could be because I didn't have full extension before the surgery.

I will keep reading your entries with interst as you progress to full weight-bearing.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on January 23, 2009, 09:22:12 PM
So I just got official confirmation for mine on March 5th. Ehhh
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on January 24, 2009, 09:55:26 PM
Well as i type this i am post op day 9! What can i say! I went to theatre at 3pm and was back on the ward at 7pm. When I came round from the anesthesia I had no pain in my leg as I had been given a nerve block. The hip was a different story though and took a few shots of morphine to get the pain under control. It was about 18 hours later that the nerve block wore off and i stayed on morphine, tramadol,paracetomol for the next couple of days. My brace and bandage were removed on the Saturday. The wound is down the outside of my leg and dissolving stitches (great) The stitching is great a very thin line and not at all what I expected. Lots of nurses have commented on how neat and thin the wound is. The wound on my hip is about 2-3 inches and sewn the same way as the leg. I was then placed in a rom brace and OS instructed physio not to push me. I have a couple of excersises and to date still cannot raise my leg. I can bend the knee a little although the swelling seems to be stopping it a bit. I have a lot of bruising coming out and knee pain has started 2 days ago. Dont know what to make of that. It is still quite painful and I am struggling on the stairs ect. I go back to see OS on Monday and will see what he says. The brace is a bit of a torture implement,lol. The side of it runs and digs into the wound!!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 29, 2009, 12:37:23 AM
Post-Op Day 54 (Jan. 28th) - Well, I have been out of touch but things continue to progress nicely. There definitely haven't been any life altering changes but a nice steady progress.  I am continuing with physical therapy daily and am doing the leg press, calf raises, quad sets and straight leg lifts with weight. The other day I also decided to push it a little and I did wall sits and bridges on the exercise ball. My leg handled the exercises really well and was up for the challenge.  However, I was a little sore that night and the next day.  I find that if I take some Advil before bed I wake up far less achy than I was the night before. I haven't done those exercises very often as I am trying to be patient and let the bone set but I couldnt help myself.  I am not supposed to be walking yet, but, like most people, I couldn't help but see if I could walk.  Well, I can and quite well.  No pain and little limp.  Granted I am taking no more than 10 steps but I am excited. Again, I am trying to keep it mellow and behave but being able to walk and knowing it is very tempting when getting around. My leg feels strong and the bone feels healed (what do I know though).  If I was to complain at all I would say that I am having a little discomfort/soreness behind my knee.  It kind of feels like I have been hanging in extension for too long. I have noticed that through this whole process I will have ebbs and flows of pain where a pain will show up for a week or so and then go away... all part of the healing process I suppose.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 29, 2009, 12:46:24 AM
Hi chereb,

Congrats on coming so far.  I cannot believe you are already at day 9... probably way more now. Your experience sounds identical to mine with the exception of the hip pain, mine wasnt quite as bad as yours.  How great is that femoral block?  I was able to get along on Perkoset but either way once you get the pain under control all is good. I hear ya on the brace digging into the wound, they really should rethink a new brace for this procedure or something. I was really happy that the wound was so skinny too and so relieved that they didnt use external stitches or staples.  Range of motion is probably the best thing you can work on (Dr. permitting, of course) .  I hope all goes well with your OS. It gets easier everyday (physically that is), be patient and be good.  Congrats again, you did it!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 29, 2009, 12:54:08 AM
Hi tem8,

Thanks for chiming in, its always nice to hear others' experiences and to have another member of the osteotomy club. We had our procedures done pretty close to each other and it appears our experiences have been pretty similar, minus the toe procedure. I was hoping I would be able to use a cadaver bone as to avoid a scar and injury to my hip.  I will be curious to see how the cadaver bone works out.

I don't think I was brave enough to try to walk at 6 weeks, I just kind of felt it wouldn't be ready.  But, a lot happens in a week as I am now a little over 7 weeks post-op and walking feels much better (don't tell my OS though :)). I had the advantage of partial weight bearing all along to kind of ease my way into it though. Keep up the PT, it gets easier as you progress as far as pain goes but I have been told that it gets harder and harder to get ROM the longer you go. It will also help you get up to walking.

Keep me posted on your weight bearing progress as well. It sounds like we will be walking at about the same time. Look out!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on January 29, 2009, 12:57:37 AM
Hi jumpi5d,

Glad to hear you got a surgery date, although I am sure you wish you didn't :).  Let the dreading begin.  I hope you don't dread it as much as I did though.  If you are like I was it wont be as bad as you imagine.  And, it will be nice to get the whole thing over with.  Now that you have a date you are on your way to getting this behind you.  Start your prep now by getting as strong and healthy as you can, that's my advice.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on January 29, 2009, 02:50:07 PM
Hey. I had an original date of April 2nd, but was told it was getting moved up so 5 weeks from today. I don't think I'd go as far as saying I'm dreading it. I'm ready for sure but a little nervous just because this will be my first surgery ever.  I've been dealing with pain since I was 12, and I'm 19 (  almost 20) now and I can't wait to get it behind me and be getting better. I'm trying super hard to get as ready as I can. I'll have a 14 hour car ride home after surgery that I'm not looking forward to. It'll be 5 or 6 days after surgery though and were going to divide it up into two days.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on January 29, 2009, 08:38:57 PM
Just another quick update from me. sure are doing good! Keep it up! I am now day 14 and managed to make toast for myself today! I know it does not seem like much but it was a victory,lol. I had to stand with the crutches and eat it though as I cnat carry anything! I was back seeing my OS a few days ago. They retook xrays and my those screws look huge!! The had to open the wedge as far as it could go hence the hip pain being so bad as it was a large bone graft! He said everything is looking good and my leg is so straight! The wounds are healing well too. The OS asked to see me standing with the brace and had one look and put me straight in plaster! So I have plaster thigh to knee and below knee to ankle with hinges holding them both. That way i still get to bend the knee. It has made so much difference to the pain. The pain is much less and its easier getting out of bed ect. The brace apparently was just not suited to my leg. The OS was quite apologetic about it. I am coping with my physio so much better with the plaster. My hubby goes back to work on Monday so I am on my own from  then. I have two school runs on crutches to make daily so it might help me in the long run!! My four year old im sure will run rings around me. My nine year old is quite helpful sometimes so im sure we will cope! 

Jumpi5d....Good luck with the upcoming op. The first week or so is the worst and then it starts to get more manageable!

I go back to my OS in 4 weeks and am hopeful that the plaster will come off then!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on January 30, 2009, 07:04:07 PM
I'll be in the hospital for most of my first week. I have surgery on Thursday and he's planning on keeping me until at least Monday, then I have a 14 hour ride home, ew. Were gonna split the drive up into two days.  It's crazy to think it's just over a month away.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 02, 2009, 07:41:27 PM
Post-Op Day 59 (Feb. 2) - Last Saturday was my 8 week post-op anniversary. I can't believe it has been two months, in many ways it feels like it has been 2 years. When I look back, the surgery feels like it was forever ago.  But, when I look back, I can see how far I have come.  That said, I feel like I am only partway up this mountain.  I have tried to keep from walking , doctor's orders, over the past few days.  It was getting a bit more swolen and sore when I was putting too much pressure on it even though the actual act of walking didn't hurt and felt pretty easy. I am aching to see my doctor and see the xrays.  I am so anxious to see how much healing has happened since my last visit. If the bone has filled in then I will feel a lot better about walking, not coincidentally, I will also then be allowed to walk.

My strength remains the same.  I continue with leg press and the usual.  I really haven't moved my weight on the leg press up since I get some interesting pain feelings throughout different parts of the joint when I do the exercise. I don't know if, at this point, pain is supposed to be a limiter or if I am supposed to work through it.  I haven't been going to outpatient physical therapy since the first of Jan since I already know what exercises I am supposed to do.  Once I am allowed to walk I will go back and get a professional's opinion on where to go and how aggressive to be.

Just in case the sentiment isn't coming through I will be more clear:  I feel as though I am in limbo.  I feel capable to walk but don't know if it is smart or if I should.  I want to push the rehab but don't want to do too much and jeopardize healing. I want to start planning to get back to some of the pre-op/normal life things I was able to do (i.e. volunteer, take classes at the gym, go to the beach, go on vacation, etc.) but don't know how long it will take until I am allowed to or capable to.  I am just waiting....waiting to see my doctor and some xrays....trying to be patient.  I hope that in a month or so I will be able to provide the hindsight that will help those of you who are coming up on this time in your recovery understand and get through it wisely.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 08, 2009, 10:22:41 PM
Post-Op Day 65 (Feb. 8) - Yesterday was my 9 week anniversary.  I am really excited right now because I see my OS for my second post-op visit on Thursday.  During my last visit he told me that we would take x-rays and if my leg looked good he would let me start walking.  Even though I have done a little walking so far, it would be nice to have his blessing and know that I am not doing any damage. I have four more days until I get a little more freedom and a little bit of my life back. I also want to talk to my OS about what to expect as far as progress when I start walking.  How long will it take to get rid of any limp. Is my knee going to swell? How long of a distance should I walk for?  They go on and on.

Right now my calf has been bothering me a bit and I wonder if some of the other muscles are going to act up given my new alignment. I really expected that my recovery would be faster than it has been.  I knew I would be on crutches for a while and I knew the timeline, which I am on target with. But, I thought my leg would be feeling a lot more normal by now.

I am getting some good strength gains lately and am seeing a bigger quad muscle with more tone and noticeable strength on the bike and leg press. I am keeping up with the ice still, icing after any walking I do and after rehab/the gym. I have a job interview tomorrow and am not sure if I should bring the crutch or walk.  I will walk if I can do it without a noticeable limp.  We'll see... wish me luck with the job interview and the OS. ***my fingers are crossed***
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 09, 2009, 09:40:33 AM
Aturpin- Good luck for the interview! I know how you feel with things not going quick enough. I am so bored now and feel everything is at a standstill. However i try not to dwell on it too much or i would get depressed! You will get there eventully and everything seems good and on course for you! Hope the xray gives you the good result you need to move forward. Take care. :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 10, 2009, 01:20:39 PM
Atuprin hope you done mind me keeping jumping in on your thread!

I am now at post op day 25.

I have been taking tramadol,paracetemol and diclofenac. Decided to try and drop the pain meds. Spent all of yeasterday and all night in pain! Guess im not quite ready to give them up yet! The inside of my knee is very painful. I hoped that it would be a bit better by noe and im guessing there will be more of this until i am weight bearing again and everything settles in position. I had my first outpatient physio this morning. There was nothing really new they gave me as i have already been doing the ones from hospital. The physio re-emphisised that I had not to be pushed with aggressive physio for now and that once i am weight bearing the hard work starts. The cast is a total pain. I am hoping that on the 24th the bone has sufficient healing for it to be removed. It is so heavy,lol Fed up dragging it about with me!! My 4 year old is running rings around me at the moment. She seems to know that mummy cant quite catch her to put her on the naughty step!!! The physio seemed quite pleased that I had no ankle or foot swelling and says its a good sign. Dont know about anyone else (would beinterested to know) but my foot since the op is a different colour than my other one. Somehow I have convinced myself that when the foot returns to normal colour the bone has healed? Anyone care to put me right on that? I have been questioning lately have i done the right thing. It just seems so long and im only a few weeks in! We have really bad snow and ice just now and getting out just is not an option just now! I suppose that is making me feel the time thing even more.

Aturpin good luck for Thursday...hope you post the outcome of your follow up. Take care
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 11, 2009, 07:14:13 AM
Hi Chereb,

I remember very vividly the pain that came with getting off the pain meds too soon.  No fun. My best success with getting off the meds was to ween myself off of them.  I only took them at night and started cutting pills in half and that was pretty successful.  I can't imagine how much harder it must be to be in a cast, you're tough....and with a 4 year old too.

As for the foot coloring, I think I might have had a darker tint to the foot on my surgery leg for the first week or so but not much longer than that.  I would venture a guess that it may have to do with circulation and the cast.  I was advised to do ankle pumps after surgery to help the blood flow better.  I don't know if you have been told to do this but it might help.  As for the bone healing, I think it is pretty well accepted in the medical community that bones take a minimum of 6-8 weeks to heal.  If that happens to coincide with the color coming back in your foot then great, but I wouldn't try to walk or mess with the leg before then.  With the kind of "break" we have had, I have learned that it just takes time to heal.

I understand your frustration with the amount of time, the boredom, the pain, the doubt, all of it. Only time will tell if you did the right thing and there is nothing you can do from here except definitely can't take it back. Try and be as positive, patient, and hopeful as you can muster.  Time will pass, it will feel like forever, but it will get here. You will also have good and bad emotional days. Days where you are frustrated and bored.  This surgery is as much a psychological and emotional battle as it is a physical one. You're doing a great job so far, keep up the good work and be strong.

I will definitely keep everyone posted on what my OS has to say on Thursday. Till then....
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 11, 2009, 02:33:42 PM
Hi Aturpin,

Thanks for the wise words. Feeling better today and probably because the pain is less. Good idea cutting them in half. I will give it another week and try again. Will half my dose and see where it takes me. I had to go and pick up my 4 year old from nursery for the first time. What normally takes me 15 mins took an hour,lol. Still I felt good that I managedeven though the arm muscles were begging to get the crutches down. I am not going to try and stand on it just yet. I am only 4 weeks post op and would be terrified of doing any damage! Like you i look forward to my next follow up and hope that I can lose the cast at least! Its great to read your progress and imagine myself there in a few weeks. How does the walking feel? Is it very strange and hows the muscle tone? I have been doing foot flex excersises, left,right, up,down ect. Is tha what you mean? Also been paddling them. I have thigh presses, leg raises and knee bending excersies. I am struggling with the knee bends or maybe i just expect it to be quicker? I am just going to keep trying and eventually it will come right. How did you feel with the first partial weight bearing? Did it hurt?     
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on February 13, 2009, 07:05:14 PM
Hi.  I have been lurking here for some time and following your progress for the last week since I saw a top OS here in Chicago who recommended a DFO and a possible meniscus transplant and articular cartilage graft if I am a good candidate for those. Background I am a 45 year old male triathlete. I have completed 5 ironman races in the last 7 years and scores or shorter races and stand alone marathons. I also enjoy skiing. 2 years ago I had a man v. dog collision to my left knee. 14 mos ago I had a arthroscopic meniscectomy and debridement of cartilage -- focal defect in weight bearing area of lateral femoral condyle. I did PT and returned to running and training last spring. I completed Ironman Canada last August in considerable pain. Now my lateral compartment has collapsed and I have a severe valgus malalignment. My old OS said my only option was to manage the pain and hold off for a TKR, which I would need in 2-4 yrs. My new OS is recommending the DFO, but he asked me to wear an unloader brace for a perioid of time to see if I am a good candidate.
I am following you to see what I'm in for! I have to say your recovery is not as rosy as that painted by my OS .  I am probably going to schedule my surgery for late August and hope to be walking by Halloween. Reading your posts makes me think more like Thanksgiving. Thanks.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 16, 2009, 07:37:15 PM
Post-Op Day 73 (Feb. 16th) - Happy President's Day everyone.  I hope none of you readers had to work, especially the post-op readers :).   Apologies for my lag on my walking update.  Great News!, I can walk!  I saw my OS on the 12th and we took xrays and he was really really pleased.  My bone has completely healed, you can't tell where the saw went through and the gap has completely filled in with bone.  He said my recovery was the best it could possibly be including my range of motion and he released me to return to my normal activities including walking, bike riding, all rehab.  He also said that in less healthy people he would still expect to see some fissures or lines where the bone was filling in at this stage, which was just short of 10 weeks. He did, however, caveat the whole thing by saying that I should not run, jump, etc. since my leg is weaker and I still have cartilage issues in my lateral compartment. Even though the bone is healed, I couldn't imagine running or jumping right now, it would be so painful and I dont know if I could even physically perform the motion.   To celebrate my progress I left my doctor's office and took my first post-op spin class.  I made it through the entire hour though I have to confess that I did not get out of the saddle for the second half of the class as my knee and leg was fatiguing and I didn't want to overdo it on my first day back. The following day my knee was a little sore.... By sore I mean it feels tight and kind of warm.

I am now about 10 weeks and 2 days post-op and have been walking for 4 days.   I am walking with a limp but I am really trying to concentrate on walking properly.  I think I will have to go to physical therapy to get their help with learning how to walk again and what exercises to do. I am so relieved to see that my leg has healed and the surgery has been successful so far.  Walking hasn't made my knee feel any better or worse, just the same. I am taking this as a good sign, a sign that I am ready to walk and the leg can handle it. Now it is up to me to have the dedication and discipline to learn to walk and rebuild my muscle, strength, balance, etc.  I can tell this will not be easy but I am well on my way. I am really excited to be walking, I feel like I can do a lot more things now and I get a lot of my life back.  I haven't gotten all of it back yet as I can't go hiking or walk for long periods of time, but now I can go shopping and carry things, run errands, tour new homes (part of my job), and just go through life with more ease and fewer stares. Its a really nice feeling. I am really pleased with the outcome of the surgery so far and look forward to getting back to 100%. This has been a great mood lifter for me.  I will try to post pix of my xrays, my leg looks bionic with all of the screws and the plate... kind of a trip.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 16, 2009, 07:46:53 PM
Hi Chereb,

I'm sorry I haven't gotten back to you sooner.  I posted the results of the doctor's visit last Thursday but I wanted to answer your questions about how walking feels and how it felt to bear weight for the first time.  I hope you are hanging in there ok and you haven't pulled your hair out in boredom yet. Don't you have an appt. with you doctor coming up?

Bearing weight for the first time was a process in a way. I started by testing the leg by trying to stand with my weight distributed evenly between the two legs to see how it felt and then I progressed to limping around and then walking around. I never felt like I was pushing it or that it was too soon and if I felt any pain or discomfort I stopped immediately.  I can't explain the mental feeling but you might understand what I am trying to convey because you are in my shoes.  I feel an instinct about what I am capable of doing without testing it... its like I mentally know without trying what I am capable of.  For instance, after I woke up from surgery and had to go to the bathroom, I knew that walking was going to be impossible even if I was allowed to and I didn't think that crutching was even a good idea. A week later, I started touching my leg down when I was crutching because it just felt like it would be ok.  I didn't try doing anything until it made sense to me mentally and I felt comfortable with the idea of doing it. When I finally started bearing weight, it didn't hurt. It hasn't hurt at all so far. It definitely fatigued in the beginning and would get stiff but it never hurt. I hope that answers your questions, I wish I could describe it better.  You'll find out soon :).

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 16, 2009, 08:10:35 PM
Hi Aturpin ;D

Many thanks for the answers. I know what you mean. Itslike raising my leg onto the sofa. t first I used the other leg to support it and then one day i just felt ready to try lifting using the muscles in my leg. It was a bit sore at the knee but i was so happy as it felt like an acheivement. Now i am standing on my two legs evenly positioned but no weight on the op leg if that makes sense. Could not have done that without being very unstable a couple of weeks ago. I sort of fell the other night. Caught my crutch the wron way, spun round and reactively put the leg down to stop me going backwards downstairs. I felt no pain in my thigh but a good bit in my knee. Was worried i might have done some damage but nothing i can do about it now. It happened! I m going for PT tommorow again and back to OS on Monday.

I am so happy for you. I had a big smile reading your update as i know you have been desperate to get to this point. Well done you!! I bet you feel rather jubilant now. I know i would! Its great that the bone is completely healed now and just remember not to push too hard! I am sure the limp will diminish through time. Do you still have the crutches? Or are you completely off them?

I seen my xrays at my first post op and it really is a sight to see all those screws and the plate. One of my screws goes through the full bone and pokes out the other side! Its amazing to think they are inside you!

Good luck with the recovery, you have come through the worst bit now. Please keep updating your progress as its very helpful to me!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 16, 2009, 08:15:23 PM
Hi Tailwind,

(I like your name, Tailwind's are my favorite running shoes :) ). †It sounds like you have been through quite a knee ordeal. I have a ton of respect for all of those Ironmen out there... its truly an amazing feat to complete that race. So you are a runner, and not just a runner but a marathoner, a skier, you've had an arthroscopy, and had an acute injury to top it all off. †Your knee has taken quite the beating. I can't believe you were able to run marathons on your knee with the cartilage defect and with what you have been through. I am sorry to hear your knee is so beat up, you really don't appreciate how great knees are until you wreck them.

It sounds like you have really done a job on your knee and you have some decisions to make. †If I understand your dilemma, you have two options. †1) Do nothing, try to be mellow and control the pain for a couple of years and then go for a TKR. †2) Do a DFO to take the pressure off your lateral compartment as a means to control the pain and perhaps put off a TKR. † I don't think there is any question that you have a TKR in your future at some point given your synopsis and the damage done to your knee so it is just a question of whether or not it is worth going through the DFO or, in other words, will the DFO give you some relief in the near term and put off a TKR in the long term? †I think the Dr wants you to wear the unloader brace to sort of mimic what the DFO will do and see if it gives you some relief. †If it does, the you can only imagine how great a DFO will be in relieving your pain. †I have read some posts of people who have tried the unloader braces and weren't able to get the relief they were looking for until they actually did the DFO so don't put all of your eggs in the basket of the unloader brace.

I hope my experience has given you some insight into what you are in for but also keep in mind that everyone is different and yours could be even better. †You are an athlete and I think athletes recover really well from surgical procedures because we are healthy, we work hard, we are determined, we have a good perspective on set backs and expectations, and in large part, we take good care of our bodies (even though sometimes we abuse them). The unfortunate and frustrating part of this surgery is that it doesn't matter how hard you work or how well you take care of yourself, healing just takes time. †That's not to stay that you can eat hotdogs and kick-it and expect a good recovery because I think exercising and eating well is key, but what I am trying to say is that you can do your rehab religiously, eat 100 fruits and veggies a day, eat tons of protein and drink gallons of milk and it still takes time to heal. I think your time frame is very realistic; if you have surgery in late August I think you will definitely be walking by Thanksgiving and you will be flirting with walking around Halloween or the first week in November... assuming you have no complications, of course. Part of this depends on your OS's philosophy too. †Also keep in mind that my OS told me 6-8 weeks to walk (I think he did this to keep my hopes up even though he knew it would be more like 10 weeks).

If you can do Ironmans and marathons I have no doubt this surgery will be very doable for you... I hesitate to use the word easy because it isn't easy no matter who you are, but you will be just fine. The physical pain will pose the smallest issue to you while the time frame and lack of mobility will probably pose the greatest issue. No matter what you find to be your particular challenge, you will get through it and you will likely be better for it.... patience is the key. † Good luck and please feel free to ask any questions and use me and my experience for your benefit and peace of mind.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 16, 2009, 08:21:34 PM
Hi Chereb,

It sounds like we are on the same page... you just know when you are ready.  Bummer about your fall but I wouldn't worry about it much.  I think I had 2-3 falls where I put my full weight on the surgery leg instinctually to prevent the fall.  I had the same sensation as you in that it wasn't very painful, very scary, but not too painful.  You likely have a decent amount of bone filling in the gap and the plate is there just for those situations to protect your femur. I think you had a couple of falls a day you would have an issue.  Short of that or a big fall down the steps I think you are fine.

I am completely off crutches, haven't even looked at them since I put it in my car after my Dr.s appt.... its sooo great, those things are like a ball and chain after 10 weeks.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 16, 2009, 08:25:03 PM
Hi Aturpin. Glad you dont need the crutches, they certainly are a ball and chain! What i forgot to ask was do you still have the brace on? if you do have you to wear it much longer. Thanks for taking the time to answer all my questions. :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on February 16, 2009, 09:31:55 PM

Thanks for the long reply. You are spot on with your assessment of my mind set as an athlete. We are prepared to work harder to make things happen and sometimes patience and time are the only thing that helps.

One part of my post you overlooked. While I'm having the osteotomy, I'm also having a biologic knee restructuring.  Meniscus transplant and cartilage plug transplant. My OS told me that while there are no guarantees, if all goes as expected I can avoid a TKR and possibly get back to triathlon. I don't think I will ever do another IM and probably no more running, but I'd like to continue my active lifestyle and, most importantly stay molbile and pain free!

I've had a good response to the brace in the 4 days I've worn it.

I was wondering if your doctor suggested walking in a pool as a bridge from the crutches to regular walking. Also, do you swim and what did your doc recommend regarding that?

I hope you keep progressing and you keep us posted. Thanks.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on February 17, 2009, 12:09:05 AM
Sorry I haven't posted to much. I'm still trying to get things ready. My surgery is in 16 days, its crazy to think that it's so soon.

 Aturprin Congrats on getting off the crutches!!! I bet that's a really awesome feeling. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 17, 2009, 05:04:05 AM
To Chereb:    No brace, no crutches, nothing at all supporting me.  I wore my brace for the first 6 weeks post-op but since then I haven't used it.

To Tailwind:  Apologies for the oversight.  It sounds like you are having both the surgeries that I am scheduled for at the same time plus an extra. I don't know anything about the meniscus transplant so I am useless to you in that respect.  However,  I am also going to be having a cartilage plug transplant... the orthopedic name for my procedure is OATS. I was hoping that I could do both the DFO and the OATS procedures together but my OS recommended I do them in two separate procedures... needless to say I was disappointed with that recommendation because who wants to go through knee surgery twice, back to back?  Nevertheless, his rationale was sound and it was this.  One of the keys to successful cartilage transplant is getting blood to the cartilage so it can re-vascularize and become one with your knee. It is my OS's philosophy that the blood and healing properties that are necessary to heal the cartilage, get obstructed and shared with the DFO site when they are done together, thereby not giving 100% healing to the cartilage site. I got many opinions before embarking on this surgical journey and one of the doctors I saw suggested that I do what is most comfortable to my OS, putting him out of his comfort zone may bring an unnecessary amount of risk or room for error.  You want your surgeon as comfortable and confident as possible. Additionally, the same doctor said, rather candidly, that doctors are humans too and if they go into surgery with multiple very serious and technical tasks, often the individual tasks may be compromised. For instance, if you knew you had to perform an exacting, very tedious operation you might get fired up for it.  But, if you knew you had to perform 3 back to back very tedious, exacting operations you might become overwhelmed and you may become fatigued during the operation before it is complete.  Just some food for thought.

As for returning to activity, that is a decision that is both personal and also informed by your OS's own philosophy.  It is the philosophy of my OS that I should never take another running step as long as I live.  To him, he doesn't think the risk and the wear and tear is worth the risk or acceleration towards a TKR. I am 27 years old so I have a lot longer to go before I am eligible for a TKR also and I need to make my knee last.  That said, I fully intend of keeping up my active lifestyle and have adjusted from running and jumping and track and field to swimming and biking and hiking. I have had knee problems for too long and with enough intensity that I know that I don't want to deal with this any longer than I have to and if I have to cut running out to avoid it then I will. At the same time, I have another OS I see who encourages getting back to any activity you want and regales me with stories about athletes he knows who have had the same procedure who are now doing tris and playing beach volleyball.  Like I said, its a personal decision.

My OS doesn't have a lot to say about my physical therapy and has not recommended the pool.  However, the physical therapy place I went to suggested pool walking as a means to practice normal walking before I was allowed to bear full weight....they even had an underwater treadmill. I have been swimming since surgery but had to wait until my wound was completely healed.  My OS recommended no flip turns until I was allowed to bear 100% weight and suggested I use one of those thigh buoys to take kicking out of the picture in the beginning. I really didn't have any problem with flipturns and continue to do them.  My leg fatigued a little when I swam laps in the beginning so then I ran in the water (no floaty and not touching the bottom) and I get a really good workout. I usually do intervals of all out sprinting and treading water and it gets be super tired....great workout.

Glad to hear you are responding well to the brace, that's a great sign. Keep the questions coming and good luck with you surgery prep... enjoy your freedom every second you have it  :).
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 20, 2009, 05:47:30 AM

I am in nearly the same exact situation as you. I visited my OS today and I was told that I will have to have an exploratory arthroscopy so he can see the condition my knee is in to decide on one of two options:

1. A DFO with cadaver meniscus transplantation. This all depends on how much of my meniscus is still intact, since he can't really tell well from the contrast MRI I had.

2. A DFO with cartilage cell transplantation. I have about a quarter-sized lesion all the way to the bone on my tibial plateau. Right now my OS believes that there may be softening of the lateral femoral condyle as well because it's most likely rubbing on the area of no cartilage on top of my tibia.

Currently as it stands I've already had the following procedures done to try and fix my pain and problems:
-3/05 - Arthroscopy for debridement of osteochondral defect
-12/05 - Arthroscopy medial meniscal repair (received a meniscal tear following being rear-ended in a car accident)
-10/08 - Arthroscopy lateral partial menisectomy (freak accident at work, just turned around and felt sharp pain and bam, ended up tearing my meniscus)
I've also tried braces, Synvisc injections, cortisone injections, anti-inflammatories...nothing provides relief.

I'm 23 years old and have been living with knee pain for about 7 years now, all which started from a minor soccer injury and everything has gone down hill since then. My doctor did want to try the unloading brace for a few months before surgery, but I know the surgery will be inevitable as just wearing a brace will not fix the alignment and cartilage issues I'm facing. As with everyone else that has been talking about osteotomies, as soon as my OS mentioned the word and discussed the procedure, I became freaked out. I'm not really sure how I feel about having the largest bone in the human body purposely broken to only have it screwed back together with metal. However, I am looking more and more forward to this surgery, as I believe it will finally provide me with relief I'm looking for and allow me to get back to the things I enjoy doing without worrying that my knee will give out on me, lock, or end up in extreme pain.

Do you have a surgery date set yet? I forget how long you will be wearing the unloader brace for before you go back for another visit. I was hoping if you ended up having surgery before me you'd be able to provide me with information on how your rehab/post-op experience is going. My OS is supposed to be calling me back in the next few days to set up my first sugery appointment, which will most likely be next month. I find everything that everyone has written very helpful, as it helps me to know that I'm not the only one in the world with such a messed up knee! :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 20, 2009, 05:54:54 AM
Aturpin, Cherub, and everyone else on this post:

It is so good to hear from everyone's personal pre- and post-op experiences. I only found out about 2 weeks ago that a DFO is in my future and I freaked out the first time I heard it and became really uneasy about the whole thing. Most of my history and information is in the post I just wrote before this one so I will try not to repeat anything. I know my situation is different from others here in that I will be having either a cadaver meniscus transplantation or cartilage cell transplantation (autologous cartilage implantation, or ACI for short) along with my DFO. I know this will significantly increase my rehab time since my OS told me so which will be very unpleasant, however I believe it may be nice to just suffer from one large major surgery and be done with it.

So, although I'm not sure what my road to recovery will end up being just yet, it's nice to know there's an extremely large support system here, which I'm glad I found! :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on February 20, 2009, 12:29:05 PM

No date yet, but I'm shooting for mid-August. This is for several reasons. First, I own my own business and I'm super busy right now. Second, my wife will be helping me out and I don't want to ruin her spring and summer being my nursemaid. Third, I want to enjoy my summer and also strenthen up my leg for what will be a tough recovery.

My OS asked to see me again 8 weeks after starting to use the brace. I will see him early April.

It looks like you will be going before me. I hope you will diary here with your progress. Just reading about all of this has eased my anxiety quite a bit. Also, my OS gave me a DVD with a ton of actual videos of the surgeries. Watching these - not for the squimish - has really increased my knowledge and comfort level.

Good luck!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 20, 2009, 04:45:29 PM

It seems like you've thought about what's best for you in picking a date. As for me, I'm shooting for as soon as possible for a couple of reasons. First, I have really good insurance through my job and want to have the surgery while I'm still covered. Second, I have a job that will offer me disability pay while I'm out. Third, and most important, I've applied to accelerated Bachelors of Science in Nursing programs, and although I applied to begin the program in August they have two start dates each year, January and August. I'm hoping that if I get in I'll be able to postpone my enrollment until January, and I'm hoping if I have the surgery soon enough I'll be okay by then to handle everything. Also, my doctor said that some times of year are better than others for meniscal transplants, mostly in part that they are more available during certain times of year like summer (since many people are out and about being wreckless on motorcycles and other activities).

I am definitely planning on journaling on this site after my surgery, as I have learned so much from other peoples' experiences and if I can add anything to this for others who may be in the same situation, it is definitely worth it. I'm hoping that being young and making it through three other surgeries so far (even though small in comparison) will put me in a better post-op situation. I also have an Exercise and Sports Sciences degree and have worked in rehabilitation settings as an athletic trainer, so I know I just need to push myself and do everything possible to "pre-hab" prior to surgery, and then get right back to rehab after.

Well I'm glad to hear the brace is working with you and I wish you the best of luck with everything and your knee. I am also hoping that you will journal about your experience (even though yours may be after) so I will have something to compare to. :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 20, 2009, 06:49:18 PM
Hi nikkiluv,

Welcome to the club, aren't you just so thrilled to be a member  ;)?  You didn't mention in your post how severe your malalignment is.  It must be great enough to warrant your OS recommending a DFO but I was just curious.  It sounds like you are having a lot done at one time.  Is it going to be a game time decision what type of cartilage treatment you will have done?  A good friend of mine had an ACI done and he told me about the procedure.  Have you already had your cartilage harvested and grown in a petry dish or are you harvesting the cartilage during this procedure?   

Mentally, I am still torn about which I would prefer 1) all of the surgeries done at once, or 2) multiple steps.  The obvious choice is to get them over with and move on but the more I think about the more I wonder if having them done all at once becomes overwhelming both psychologically and physically.  You must be both brave and mentally tough to choose this path.  I think we are all in similar boats in that we have been dealing with our knee problems for so long that we will do anything to remedy our situations.... including this seemingly barbaric surgery where they saw through our femurs and screw in a plate. I will be very interested to follow your surgery and recovery.  Best of luck to you and keep us posted.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on February 20, 2009, 08:54:25 PM

I have not scheduled the surgery yet so I havent talked to my OS about "availability." I get a little sad thinking about where the parts come from and how the seasons affect "supply and demand."

Another nurse posted her diary after DFO here. You may find it interesting.

I am guessing that if all goes well with you and your timetable works out as planned, you will be fully recovered and will have no need to look back on me or for anything else on this forum! I hope that is the case.

Stay in touch.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 21, 2009, 03:50:25 AM

It saddens me greatly to think that I would be taking a piece of someone who most likely died a tragic death and is very young. However, I have been telling myself that there are other people worse off than I who (as horrible as it sounds) are hoping every day that someone dies that matches them so they can get the heart, liver, kidney, etc. that they are in desperate need of. And you are right, I am very happy to have found this forum, however it would be a blessing to be "cured" and pain free and not have to look here for advice or anything else here :) (although I'm sure I'll still be here to read others' stories and offer insight).


Oh yes, I'm clearly thrilled to be a member of this club, haha. To be honest I am not actually sure of how bad my malalignment is, however after I had x-rays and my doctor measured my Q angle on the screen it is obvious that my right leg is more "knock-kneed" than my left, which appears fine. (The OS I am seeing now is not my original OS. My primary OS referred me to the OS who is more known for his work with osteotomies and cartilage defects, since my primary OS has done all he can for me at this point).

As for my surgeries, I am currently planning on having an exploratory arthroscopy where at that time my OS will determine the condition of my meniscus and see how big the cartilage defect on my tibial plateau is. At this time, if he decided that my meniscusall and osteotomy at the same time once a meniscus becomes available. However, if he decides that my meniscus is okay and I only need the cartilage defect fixed, then he will take the biopsy during this surgery and then I will have both the osteotomy and ACI together once my cells have grown enough. Although I do not want two more surgeries, I am fairly glad that I am having just the exporatory arthroscopy so then he can tell me which direction he is planning to go in. I'm not sure I could go into such an extravagant surgery not knowing exactly what is going to happen and what the outcome is. I was already a mess during my first meniscus surgery when my doctor did not know if he was going to be able to repair it or have to perform a partial menisectomy. He ended up repairing it which I wanted and it seems to be doing really well. However, my second meniscus surgery I wasn't as lucky as it was in a area of no blood supply so it had to be a partial menisectomy. I remember vividly waking up from surgery wanting to know what the end result was, and crying after he told me it couldn't be repaired because to me having to have even the smallest bit of cartilage missing was devastating.

To address both the surgeries at once, I'm not sure if I am brave and mentally tough, or just crazy. I believe my doctor likes to go the route of performing the minimal amount of surgery needed it seems like. I understand the multiple step route because you may not be in such rough shape afterwards. I may have considered this route if I wasn't working with such a short time frame, however I don't believe I have any other choice or want more surgeries than I have to (since I've already had 3 and 2 more on the way). I really am concerned about the amount of pain I'll be in following surgery and what my leg will look like. I have thoughts of being in extreme pain and my leg looking like it was mangled. However, I have been taking comfort in the fact that others share these same thoughts, and those who have had the surgery haven't been in as much pain as they thought they would be and their leg doesn't really look that bad.

Overall, I know the road to a better knee will certainly not be easy and will be filled with it's fair share of potholes, speedbumps, and other obstactles. However, I believe the only thing that is keeping me going and making me persevere with it all is knowing that this may actually "cure" me and I may actually be able to live with a knee that is pain free. I've felt like hope was lost so many times and that maybe I was just to deal with the pain for life. It's so hard to explain to other people why we want to do these extreme things, but unless you've dealt with such pain that limits you for so long they'll never understand it. I'm just so happy to have found this forum!! :)

Wow sorry this is REALLY long!! hehe
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on February 21, 2009, 01:05:01 PM

Your discussions with your doctor and the logic behind the prelim scope sound a lot like my OS, Brian Cole in Chicago. I think it all makes a lot of sense.

With most procedures being "minimally invasive" and scope recipients being back on their feet in a few days, its  a lot to digest that you will be so physically limited and that healing and rehab will take a lot of patience and time. You do need to be mentally strong and tell your self at any given point in time -  2 weeks post-op, 8 weeks post-op, 4 mos post op, that its just 1 more day in the 150-180-270 you need to where your are headed. You can do that!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 22, 2009, 11:09:36 PM

I couldn't agree with you more. I definitely feel like I will be more prepared for what lies ahead after the prelim scope. I would feel very uneasy about going into such a major surgery with two very different outcomes (just an ACI vs. mensicus transplant). It's so easy to just lose it when you become overwhelmed by everything whether it be not being able to do things on your own, the pain, the rehab, etc. There have been times where I've broken down and just wanted to quit, but I just had to keep telling myself to take things one day at a time and by doing that I'm one more day past the hard part and another day closer to being recovered. I'm very lucky and grateful that at the moment I still live at home while I'm in between going back to school, so I have a large support system of family and friends that will be right there every step of the way to help me get through. It also makes me feel better knowing that my primary OS who referred me out had a DFO and ACI done by the doctor he referred me to and he's better for it. Hopefully we'll all feel the better afterwards!!

Thank you so much for the encouragement of being able to get through :) I greatly appreciate it!!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 23, 2009, 03:14:05 AM
Post-Op Day 79 (Feb. 22nd) -  It has now been 11 weeks since my surgery and 1.5 weeks since I have been walking unassisted.  My progress since starting walking has been slow.  I introduced a few new activities/exercises to my workout routine and the results were luke warm. One activity I began doing again is yoga.  I found some poses to be surprisingly difficult (twisting and contorting) while others weren't so bad (balancing and lunging)....granted I was lunging gingerly. My knee seemed to handle this well judging by how it felt afterward and the next day.  It actually really helped with flexion and balance.

As for rehab exercises, I added step-ups and single-leg squats.  Before anyone's imagination runs a muck I should say that my single leg squats were assisted and not my entire body weight. I did 3 sets of 12 of each exercise and like clockwork, I got halfway through the second set of each exercise and felt my knee starting to get tight and achy. The rest of the night and the following day I knew I had done something different by how my leg felt.  So, its a mixed bag.

The good news is that the stiffness and soreness has gotten to the same maximum level no matter what I do.  I haven't found anything yet that has sent me to a really terrible result, just the same pain.  I am tentative to say this because I feel like I am tempting fate but I do want to relay these feelings and symptoms. It has been my experience so far that I will have a week or two of a plateau or little gains and then a week of progress, I feel like I am due for noticeable progress as the last week and a half have been somewhat stagnant. Although I am desiring greater gains, I have been riding the bike and doing therapy everyday a week with the exception of one... this is pretty good progress from where I have been. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 23, 2009, 03:45:50 PM

Wow I can't believe that it's already been 79 days since your surgery! Although your progress is slow it's nice to know that you aren't having great difficulty following getting off your crutches. For those who have had surgery I always feel like it's so hard to not overdo it and cause a major setback. A couple of times I've pushed myself knowing I shouldn't have (I felt fine at the time of doing it) and then afterwards I regretted it.

Also, if you don't mind I have a few questions for you. I'm not sure if you mentioned it or not, but did you have a PCA or an epidural IV for pain control? The information my doctor gave me on how he does the procedure he uses either depending on the patient and what he feels is best, but the thought of having an IV near my spine scares me a bit. Oh, and did they allow you to use the bathroom normally after surgery, or did you have a catheter or a bedpan? Thanks :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 23, 2009, 06:57:01 PM
Wecome Tailwind and Nikkiluv :) You both sound like you have quite a journey ahead.

Jumpi5d, cant be to much longer to your surgery. How are you feeling?

Aturpin you will get there, just try and not push too hard.

Mw well i am 5 weeks and 4 days post op. Had another follow up today. Was quite upset as os said to keep the hinged cast on for another 3 weeks. However the cast had slipped and the hinges had been out of place. Thats why i could not get my knee to bend any further!! The hospital had some new braces and i had the cast removed and a brace put on!! My muscle loss was not quite as bad as i expected. Everything seems to be healing as it should and i have 6 more weeks with the brace and crutches. I am now allowed to start weight bearing and work up to being comfortable and eventually full weight bearing. I have been given new instructions to pass to my physio which are first to regain full rom in the knee. Next to work on the gait and then rebuild the leg muscles. He also said to be really patient as it could be another six months until it is fully recovered. The scar is scabbed over and im assuming because its been covered up with the plaster that is has not had the airing that the hip one had as the hip one is almost fully healed. The knee is still pretty swollen but he said it will go down! The first thing i did when i came home was have a soak in the bath! I have been walking with the crutches and it feels strange to have some weight on the leg again although not painful. I will just take it as it comes and try to be patient,lol. Im just so glad to have the cast off though and the all clear to start the weight bearing!! A little progress.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 23, 2009, 08:02:52 PM
Hi nikkiluv,

I know, 79 days, now that I think about it, is a lot of days.  To your questions, I don't know what PCA means so I will just tell you what I did and my thoughts.  Like you, I had an arthroscopy to determine the extent of the damage, get piece of mind, and put together a game plan before my big surgery.  I really, really wanted a spinal block/epidural for that procedure because it was so short and I didn't want to put my body through anesthesia.  They denied me as the block lasts for hours and I wouldn't be able to leave the hospital until I had feeling back.  Then I thought I would want the epidural for the big surgery but then i thought about it and I didn't really want to hear the bone saw or the screws or the bone opener thingy... I am glad I was asleep.  After the surgery was over and right before I woke up, they gave me a femoral block which was just about the greatest thing ever.  It kept me numb for the rest of the day and into the night (my surgery was at 7 am).  I used Perkoset for pain management from the time I woke up through the completion of week 1 (more or less). I didnt use any intravenous pain meds so I can't tell you about those.

As for the bathroom, that is a great question.  See, I was really nervous and scared about getting up after surgery so I used the bedpan for the first 2 bathroom breaks (both #1).  This was not my favorite thing, in fact, I was rather embarrassed about it....  i dont think anyone minded but me though. The first time I got up to use the bathroom was the following morning and I was shocked at how easy and painless it was.  I was also a little pissed cuz I think I could've used the regular bathroom from the beginning. I hope you don't have to use the bedpan because no one wants to so my advice is to try to get up before you abandon the idea.  No catheter, by the way...Thank God!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 24, 2009, 02:36:26 AM

A PCA is a patient controlled analgesic, which is the type of pain control where the patient is able to administer pain meds themselves intravenously through a pump. I was just re-reading the literature my OS gave me about how he generally does the procedure and he says it's usually performed under epidural anesthesia which is also the method they use to control pain. The other option is general anesthesia using the PCA afterwards. In reading the whole thing about the epidural anesthesia I was just not thrilled about it because of it having to do with my spine. Never did it even cross my mind about the whole being awake thing and being able to consciously know what's going on and such! I've had general anesthesia for my past three knee surgeries and they've only been scopes (which have all been shorter than what is expected for my big one), so I'm hoping they'll give me whatever makes me not remember a thing. The femoral block is also something to think about and ask my OS. I've read that quite a few people on here have had them and said they really helped with pain immediately following their surgery.

About the bathroom thing, that's good to hear that they let you go to the bathroom, especially since I definitely do not want to have to use a bedpan! I'm sure you're right that no one but you probably minded since nurses deal with that kind of stuff on a daily basis. Again, in the literature my OS gave me it did mention that a catheter may be used, which I guess if I have to I would pick that option over a bedpan. I'm hoping they would allow me to get up and use bathroom because I'm going to have to do that eventually after I leave the hospital so I may as well learn to deal with it as soon as possible.

Thank you very much for answering my questions. I'm sure I'll have more as the time draws near, and especially after my exploratory scope!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 24, 2009, 02:45:19 AM

Thank you for the welcome :) Yes, I have realized that I do have quite a long road ahead but I am ready to hopefully eventually be on the mend and on my way to living a life that is finally free from knee pain. That thought alone is what's helping me through all of this day by day.

As for your progress, I can't believe that you are already over 5 weeks past your sugery! Both you and aturpin have come so far since your first posts. I also think that's fantastic news that you no longer have to deal with a cast!! I'm sure things will become much easier for you now that you probably feel a bit more free and less restricted. That's also promising that you're allowed to start weightbearing after 5 weeks, especially since I've read some peoples' stories of not being able to weightbear for up to two months or more following their surgery. As much as I hate crutches and not being able to do things for myself because of them, I don't mind them as much when I am able to weightbear even a small amount.

Thank you for updating on your progress and keeping me and others in the know of how your recovery is going. It makes me feel better that even though I will have a long recovery ahead that it may not be as bad as I think and I just need to take it one day at a time. And, if I have any question about anything, I definitely know where to come :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on February 24, 2009, 04:15:45 AM

 I have 9 days! I'm ready for sure. A little nervous for the fact that I've never had surgery before though.  It'll be so worth it when it's all done. Mine is being done mainly to straighten my leg and fix the alignment of my kneecap.  I'll be sure to post a diary and lots of pictures! Photography is my job so taking random pictures will def. be a way to help me get through all this.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 24, 2009, 01:09:10 PM
Nikkiluv, I was supposed to have pca after my op. I was offered an epidural but declined as i didnt want to be awake for the surgery. That would have freaked me out. I was also given a nerve block and they dont put you as deep under with the ga this way. When i came around i did have a set up in both my arms for the pca but for some reason they didnt hook it up and the nurses just injected it through when needed. I had day one,two and part of day three on morphine. Once they started giving me an anti inflamatory the pain was really much less. The nerve block was great as i felt no pain until it wore off (except for the hip) As for the toilet i was not allowed out of bed for 24 hours after surgery so had to use the bedpan. I could hardly do it and there was talk of putting a catheter in as my output was so low. After the 24 hours i could got to the toilet by myself and the output returned to normal,lol. Must have been the thought of doing it in a bedpan!! 

I was surprised to get the go ahead to start weight bearing this soon. I have been taking calcium supps since before the op. Dont know if they help,lol. It is strange putting the foot on the floor again. If anyone is interested i might try and stick up some pics of how it looks at the minute?

Its definately a one day at a time op and you have to learn to be patient and do what they say to the letter. Take care.

Jumpi5d 9 days will fly in and before you know it the op will  be done. Look forward to the diary and the pics! The first 2-3 weeks are the worst in my opinion. Then it starts to get a little easier. Take care
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 24, 2009, 03:24:31 PM

Thank you for the information from right after your surgery. I am not afraid of getting general anesthesia since I've had it numerous times before (3 for the knee, once for tonsils) and I do not have a bad reaction afterwards and come out of it quickly. I just don't want to have any memory whatsoever of what's going on in the OR. The nerve block sounds like a very good thing and I'm definitely in favor of having one when I have my surgery as it seems to get everyone through the first day or two. Did they give you percocet as a pain reliever for home? It seems many people are given percocet afterwards however I'm allergic to it (I've had it before but for some reason had a reaction following my last surgery), so I'm assuming they'll just give me vicodin or something similar. As for the bedpan, I would assume it's extremely hard only having one leg to work with!

The calcium supplements don't sound like a bad thing. I already take glucosamine/chondroitin, fish oil, and a multivitamin every day. Maybe I should start adding the calcium in too. Did you continue to take them following your surgery as well? Glad to hear you're doing well :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: mattdsport on February 24, 2009, 03:32:49 PM
What a great diary I wish I had been able to read this when I had my distal femural osteotoemy in July 06.

Unfortunately my "open wedge" ever healed with new bone.  I had internal fixation. External fixation. Bone graft from me. Bone graft from a donor. Casting Brace the lot. All kinds of tests failed to show why my bone would not heal. Had oxygen therapy and ultra sound daily for 6 months. Nothing.

So after two years they gave up and gave me a knee and femur replacement. The same operation they would give for someone who had a bone tumor where the osteotomy break was. So it corrected the break and the artritic knee.

I am now doing good but what a proceedure. Wish they would have just give me a TKR as I requested in 06. Couldnt find a surgeon that would do it as I was only 30 then.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 24, 2009, 04:26:38 PM
Nikkiluv, I started the calcium sipps 2 weeks prior to surgery and still take them. I will probably keep taking them for another 6-8 weeks and everything is healed. :) I live in Scotland so med names may differ,lol. I was sent home with Tramadol (step down from morphine) paracetemol and diclofenac. Paracetamol is like tylenol? I assume you are from the USA and thats what i bought there which was the same as our paracetemol if that makes sense. Diclofenac is an anti inflamatory and so made the difference between awful pain and managable pain. I was not given the anti-inflam until day 3 and an hour after taking it the effects were magic. Thats how i know it worked! I am still on pain meds although tryiing to come off now but will keep the anti inflamatory up. If you can work your upper body. You need so much upper strength to drag yourself around on crutches,lol. I also has 3 scopes and they were a doddle in comparison. I was lucky if i used the crutches for a week and was allowed to weight bear immediately. The osteotomy is a whole different ball game! My os said it was likened to being in a horrendous car crash where the leg had took the impact. Long and slow! Another area i found hard was the abs Another good area to work out as you need them for pulling yourself up!

I guess if i put it in perspective i have not been put off getting my left one done. My right is on the road to healing and i am guessing in 2 years i will feel mentally and physically ready for the next one!! So it is ok. And i have never felt a bit of the athritic pain since the op! Thats a good sign i think.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on February 24, 2009, 05:39:35 PM sorry to hear your experience. It must have been very tough on you. How are you now? Are you still in a lot of pain?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on February 25, 2009, 01:05:40 AM
Hi Mattdsport,

I am sorry to hear about your experience.  I think not having the bone heal is the vary reason, aside from pain, why people are hesitant to go with this procedure.  It certainly was one of my greatest concerns.  Thanks for the kudos on my diary, I had hoped to have as much information as possible before my surgery and wanted to contribute to the pool of knowledge. Even hearing about your experience will give people out there another experience to draw from.  I hope you are doing well now and have recovered.


Sounds like you are coming along very nicely.  Great to hear you got out of your cast!  What a great relief and step forward. Keep up the work on the ROM, life gets easier and easier the more you get. I can't believe how much time has passed since your surgery, you'll be walking before you know it.


Only 9 days, how exciting.  I hope you are looking forward ot getting it done and on the road to recovery. Best of luck to you!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 25, 2009, 05:44:44 PM

Even though I've had only scopes before I definitely wasn't walking right after. My first one I was on crutches for 2 weeks, the second for 6 weeks, and my third for 4 weeks. The first was because I was silly and pushed myself too far and had a major setback. In fact, I ended up with such a horrible cramp in my calf that my doctor rushed me to the ER for an emergency ultrasound thinking I may have had a post-op blood clot (thank goodness there wasn't one). The second was because of a meniscal repair, so I wasn't allowed to walk on it or have weightbearing for quite some time as to allow for the meniscus to repair and I wouldn't rip the stitches out. The third was because my primary OS saw how much cartilage damage I have and wanted to give it a break for a bit. I have lateral OA and I had a partial lateral menisectomy, so my doctor didn't want me to be bone on bone while I was also trying to heal. If I could make it 6 weeks on crutches what's like another four? ;)

Since my last scope in October I've been biking a lot and also using weights to work on my upper body and doing a bit of abs stuff as well. Crutches take so much out of your arms! I had lost a really good amount of weight between my second and third surgery and noticed a TON of difference in how much "easier" it was for me to get around and recover. So I want to keep that up as well. Thank you for the information on that. I haven't ever prepared for my other surgeries before but I'm trying to do everything I can now so I won't regret anything.


Sorry to hear that you had such an awful experience with your surgery. Looking back I'm sure it's easy to say you wish you had a TKR but I'm sure at the time you also didn't believe you would've had all those problems. However, I'm very glad to hear that you are finally on the mend and living a life with a pain free knee. As horrible as it is to hear about your experience, it is a true reality of what could happen following such a huge surgery.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on February 27, 2009, 02:08:03 AM
So things are rolling along rather quick. Two weeks from tomorrow (Friday the 13th at that) I am scheduled for my exploratory scope to find out if I'm going to either have the DFO with a meniscal transplant or the DFO with the ACI. I'm hoping that I'll have a really quick recovery from this scope since they don't plan on doing anything (unless they decide to go the route of ACI where at that time they would do the biopsy).

Hope everyone elses' recoveries are still going strong :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 02, 2009, 08:34:56 AM
Post-Op Day 87 (March 2nd) - I believe I have officially overdone it. It was only a matter of time for someone like me ( I like to be active, I think I am capable of more than I should do and I am stubborn). I actually overdid it last weekend and have been paying for it for the past 7 days or so.  I reported on my last post that I had ridden my bike to the gym, did some therapy including single leg squats, and rode my bike home. My knee got pretty upset that night and puffed up a little bit.  The following morning it was pretty swollen so I took it easy during the day.  I couldn't help myself and I went spinning that night but left after 45 minutes thinking I was taking it easy.  I have been carrying a lot of swelling in my knee since then.  I took off Tuesday through Friday where I didn't do any exercise and it improved slightly.  Then, I went to the gym and rode the bike for 15 minutes and swam for 30 minutes, thinking I was taking it easy.  My knee may have swelled up a little bit more but it certainly didn't help my cause. I was going to take today off but went instead I went and test drove road bikes for a bike trip I am planning once I am "recovered."  I lost my balance and put my surgery leg down pretty hard, certainly nothing a normal leg would even notice, and my knee is now back very swollen again.  I truly don't think I have done any damage to the knee but it is clear I have pissed it off.

I am not sure what I should do now, aside from taking it easier, but I think I should probably see some professionals.  I avoided professional PT recently because I feel like the majority of rehab, which is strength training for the most part, is up to me.  Why pay to have physical therapists watch me do strength training exercises? I know the exercises I should be doing from my past knee surgeries and I am also hesitant to go to physical therapy because I am having a hard time finding anyone who has experience rehabbing and osteotomy since it is a relatively uncommon procedure. However, I am reconsidering and will begin my search for a physical therapist with osteotomy rehab experience in the morning.... clearly I am not doing something right with the first mistake being discretion. I am hoping a PT can give me some boundaries on physical activity and some time lines for different recovery stages now that I am walking and can take a more active role in my rehab.

I am going to begin seriously treating the swelling including taking anti-inflammatorys 3 times a day, elevating, icing every few hours and compression and see if it helps. I am disappointed with this setback especially since I haven't really been pain free or swelling free since I began walking.  All i wanted to do was to begin walking and I am grateful to be doing so but it has not gone very smoothly.  Although it is the last thing I want to do, I am committed to taking it easy until the swelling goes down significantly and will head to professional PT.  Keep you all posted....
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 02, 2009, 03:17:07 PM
Hey Aturpin,

So sorry to hear about your setback. I know it's extremely hard not to overdue it especially when you have the new found freedom of being able to walk without crutches again. The first knee surgery I had I accidently overdid it so much after getting off my crutches that I got an unbelievable calf cramp which was so bad they thought it was a post-op blood clot. Luckily, it wasn't one but the thought of having one scared me so bad. I've also overdone it a couple other times resulting in setbacks, so I'm hoping that I've kind of learned my lesson now. It's so hard to know when your knee has had enough, especially since you don't really feel too bad actually doing the activity, but then it's usually downhill the second day.

Well I hope that you get back on your feet very soon and the setback doesn't last too long. Hopefully maybe when you get into PT they can do some e-stim or or other things you can't do at home to omething to help with the swelling. Good luck.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on March 03, 2009, 05:43:11 AM
Atrupin, I hope you're doing better today. I have pre op in the morning, surgery Thursday.  I'm excited for the most part. I'll start my diary tomorrow after I get back to the hotel from the doctor.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 03, 2009, 01:19:03 PM
Aturpin im so sorry to hear of your setback. Maybe best to seek out a PT to try and get you through. It could be your knee letting you know that you are doing to much. Good luck and i hope you get back to where you were quickly.

I am almost 7 weeks post op. I am having PT every 2 weeks and trying to do what they tell me. I am working on rom at the minute along with heel strikes to make the nerves wake up. I feel it is slow but PT say its a long road and to be patient. So for the ext 2 weeks I have a new set of excercises. Heel strikes, ROM excercises, leg lifts and knee bends. Thats all i can do. The PT did try to get me to do heel strikes with the good leg but my op leg is not ready yet. So thats on the back burner for a couple of weeks. He said that all the little things will help when i go full WB. I have 3cm ,loss on the calf muscle and 2 cm on the thigh muscle. So that has to be built back up.

Other than that im doing ok.

Nikkiluv good luck with the scope.

Jumpsi5d Wishing you the very best of luck for Thursday. Please let us know how you get on when your able.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 03, 2009, 08:02:32 PM
Post-Op Day 87 (March 3rd) - I just returned from my physical therapy session, it was my first one since Dec. 31st, and I feel much better. My knee is still swollen despite the fact that I keep my knee iced and elevated all day yesterday (though the swelling has gone down and my comfort level is much better) but I have peace of mind now. It was nice to check in with a professional regarding my progress and to get a professional opinion.  My PT said that when I told him I had full ROM he thought that I wasn't telling the truth but confirmed during my evaluation that I had full ROM and that was very good.  I was able to see, and this may be beneficial to some of you out there, that full ROM is possible, great, and ideal, but, PTs don't expect people to get full ROM for a while. So rest assured if you are struggling out there but keep up the hard work. 

He also watched my gait and said I was walking normally.  He tested my strength and said that it was pretty comparable to the good leg.  Keep in mind that this is after one push.  I can guarantee you that my strength is not equal for big, heavy loads or for long and steady exertion. I was able to throw all of my concerns and questions his way and he gave me some really good advice.  He also gave me some new and interesting strength exercises.  Below are some things I was told/learned that might be helpful to you all:

- Expect strength gains but not bulk for at least 6-9 months post op.  You can't do the exercises or the heavy lifting that is necessary to get good muscle mass gains until the leg is further along in the healing process.  Many of us who also have arthritis and cartilage problems will be limited even longer since we are restricted from pounding, deep squats, jumping, etc. Don't despair though, you will get strength.

- As such, exercises should be with lighter weight at about 15 reps.  A good measure to know if you are ready to move up in weight is if you can do 30 consecutive  reps pretty easily without resting.

- Stepping up is a lot easier than stepping down (duh), so when doing therapy, step sizes for a step up can be 6-10 inches.  But, step sizes for step downs should be 2-4 inches when starting out.

- I was experiencing some pretty significant popping on my patella when doing mini squats.  After the PT stretch and rubbed my IT band and moved my patella around a little bit, the popping went away.  This is indicative of tightness in the joint that can be worked through. Also, this can be caused partly by swelling. Typically, PTs tell their patients that as long as the popping isn't painful, you can work through it.  However, in my case, he doesn't think this is something that should be pushed.

- It is normal to carry some swelling the knee, especially after physical therapy, for up to 6 months post-op.  However, it shoud diminish significantly and should take a lot more to get swollen as you get closer to 6 months.

- The PT recognized that I have reached a platueau and, given my situation, recommended that I continue with basic, mellow, therapy and not increase anything. When the swelling goes down, then I can slowly add activiities and see how my knee reacts.

Overall he said that I was doing really well for this stage of my recovery and said that I was on the right track.  But I do need to let my knee be the guide and slow down until the swelling goes down. He doesn't think that is necessary for me to come in for another two weeks as I will just be doing strength exercises and normal therapy which I can do on my own. I am glad that I went to make sure that I am on the right track and check in with a professional to see if there is anything I am missing. I am still bummed about the swelling but realize that this is a process with ups and downs.  I have made really good progress up to this point ad just need to work through or (not work as much) through this plateau. I think it would be helpful to create a daily rehab diary so it will be easier to pinpoint the things that irritate it.  This is my goal going forward.

Thanks for the support and kind words from all of you knee geeks out there.... keep up the good work chereb, you'll get there (that is my mantra now "we'll get there") and good luck jumpi5d, you'll be great!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 03, 2009, 10:46:08 PM
Atpurin, so glad you seen a PT and worked it out! At least you know you are ok and nothing damaging has been done. Your right we will get there! Just not yesteray,lol

My knee is still pretty swollen anyway but after the PT this morning it has doubled in size! Also had a little more leg pain than usual but just gonna have to work through it.

Hope everyone stays good and positive.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 03, 2009, 11:53:55 PM
Hello to all DFO's.† I too am scheduled for DFO on March 23rd by the same Dr. as Atuprin (?sp).† This site has helped me allot to see just what i am up for in the next few months.† I was really hoping I would be able to enjoy my summer outdoors doing the things I enjoy (road bike riding, mtn bike riding, hiking, surfing and probably not running this year) and after reading this, think i can do these at an abbreviated level !!
My circle of friends are all Ironman triathletes so I try to keep up with them when I can although only have done a few mini-tri's myself.† †
I'll fill in my statistics next post.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on March 04, 2009, 01:52:58 AM

I am scheduled for another visit with my OS on 3/23 where he will hopefully set my exploratory arthro surgery and the set my date for my DFO etc. I will be thinking good thoughts for you that day! Good luck!
I too am an Ironman triathlete although I don't feel much like one right now.


Hang in there. You are bound to have a few set backs. It is our nature to feel better, test our limits and go a little too hard. As an athlete, I too used to feel the PT was bull - why pay someone to watch you work out? I have since come to believe that one main benefit to the PT is to act as a governor - to bring you along only as quickly as is safe and recommended. An experienced PT will make this job 1. As for the swelling, do yourself a favor an get a heavy duty NSAID like celebrex or diclofinac. Take religeously and your edema should be gone in a week. Keep up the good work!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 04, 2009, 06:05:58 PM
Thanks for the wishes Tailwind, I hope you too get good news at your appointment. 

Aturpin, I too hope you are doing better.  It sounds like you found a great PT.  I have a PT that I've used in the past for my knee and was planning to use him again.  Maybe I too should try to find someone that has experience with DFO patients.  Were you able to find someone?  I'm in Orange County and had seen Dr. Petrie in Newport, who I believe had mentioned you in one of my visits.  Did he refer you to Bugbee?  He was one of a couple dr.s that refered me to Bugbee before I finally saw him.

Details of my injury go like this, I'm knock-kneed and had been a moderate athlete, competitions included 5 and 10ks, regular mtn and road bike riding and several centuries a year.  I never had trouble with my knees until Aug. 2005 when I had a man vs. woman running crash and my knee took the brunt of the 180 lb man.  I'm 125 lbs, 5'7".  I was told then that I fractured my tibia platuea (?sp).  I later found out through a scope procedure that I damaged the articular cartilege on the tibia.  I have tried an unloading brace but found the fit of the brace was never good enough to allow me to run.  I've experienced sharp pain in my knee, typically the day or two after any activity (I also do kickbox, lift and SET classes at the gym).  I've seen a total of 9 OS's and most had told me to change my lifestyle.  Bugbee was the only Dr. that suggested any type of fix for me.  He actually gave me this news a year ago but I held off because I had just started a new job.  SO, here I am a year later and ready to do this.

Aturpin, I'm hoping to go back to work a week to 10 days after surgery on a part time basis.  Do you think that is realistic?  My job is a desk job so other than kitchen and bathroom walks I can pretty much sit with my leg elevated.  What do you think?  Anyone?

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 04, 2009, 07:36:49 PM
Welcome KCuman, Good luck for your upcoming DFO. I see you are keen to return to your work asap. In my opinion i would say a week to ten days is too soon. But then we all recover differently. For me it would be a no though. I was advised at least 6 weeks work absence for the bone healing. I am 7 weeks post op tommorow and its still hard. I cant even get the all clear to drive again yet. I am not ready though so thats ok,lol. One thing i have learned is to be patient and take it as it comes.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 06, 2009, 01:56:22 AM
Hi KCuman,

I am so excited to here you are a patient of Dr. Bugbee's too.  Of all of the doctors and all of the bulletins boards for you to seek out I find it so cool that we both found the same place independently.  I dunno , I just think that is neat.  AND, to make it even more interesting, I saw Dr. Petrie too and he is the one that referred me to Dr. Bugbee.  I think Dr. Bugbee needs to give Petrie a nice bottle of wine or something for all of the business Petrie brings him. :).

Another ironic story: as I recently posted, I went to seek out a PT that I could trust in Orange County.  I must have called 5 different places and spoke with many PTs about their experience with DFOs etc.  I decided to go with a guy named Gary who works for Start PT in Newport Beach right next to Fashion Island. I went with him because he was candid and didn't try to sell me a bunch of therapy sessions.  He basically said he only thought I needed to come to PT, assuming everything was going well, once every couple of weeks to check in and get new exercises, etc. I appreciated his honesty.  The ironic part of the story is that he ended up being a pretty good friend to the head PT at UC Irvine name Jim Pleummer where I use to run in college.  I have been back and forth with Jim for his advice but decided to go about my search for a good PT on my own and it turns out that I ended up with a colleague of his anyway. Anyway, that is where I am doing PT now to answer your question.  I dont know where you live but if you would like their contact info I can provide it.

I was able to find a few people who said they had experience with DFOs but I also got the feeling they were trying to sell me. Its a personal choice but I would sacrifice DFO experience for honesty and overall knee rehab experience. In truth, the DFO rehab isn't much different than any other knee surgery rehab the timeline is just different. And, I was NOT able to get any good info on what an appropriate timeline is. Everyone just kept telling me to let pain and swelling be my guide and that it is subjective.  I would really like to know what the average person does.  I couldn't get it but hopefully I can provide a case study for others once this is all said and done.

As for your return to work in 10 days, I have to go with chereb on this one.  Ten days is a little quick. You can definitely do it but you will be pretty uncomfortable.  Working part time might help your cause but only if part time means 4 hours or so a day (as opposed to 3-4 8 hour days). Sititing in a chair for 8 hours straight will be tough, 4 hours might be doable.  If you can, I would take 2 weeks or 10 business days.  If you can't, definitely plan on elevating and icing on the job. Good luck to you and give Dr. Bugbee my regards, I am sure he will take just as good care of you as he did me... which is to say you are in good hands.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 06, 2009, 02:13:39 AM
Post Op Day 89 (March 5th) - I usually try to post an update once a week or so but given that I am in the midst of a plateau I am trying to post more frequently so people have something to reference if they end up in my shoes.  So,

I am doing much better now.  I actually took my road bike out today for a 50 minute ride and then got back on the PT wagon.  I won't know until tomorrow if this was too much activity or just enough but I am hoping it will be okay. After seeing my PT on Monday I took it easy on Monday and Tuesday and went to the gym for about an hour yesterday but didn't do much by way of rehab. My knee is still pretty swollen but it feels better... less tight, more mobility, more stable.  I am still working to keep the swelling down but I can say right now that my knee is more swollen right now that it was before my activity. It is kind of a double edged sword:  do rehab, get swollen or don't do rehab but don't get strength.

I can't help but wonder how much my perceived progress in the symptoms I feel is mental.  I was a little bummed and worried before seeing the PT  on Monday.  After getting his help and approval I was much more positive and happy mentally and now my leg feels better.  I really do believe that a positive outlook and attitude can work wonders for healing.  I will be working harder to stay positive.

Last thing, I forgot to mention a little tid bit that my PT told me on Monday.  He said that some studies have shown that working the good leg could improve the bad leg, I dont know how but he said it was neurological.  Some disagree with this but hey, it couldn't hurt. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 06, 2009, 11:09:23 AM
Hi Aturpin, wonder if i can pick your brains for some advice?

I am now day 50 post op and struggling with my rom. Very tight and painful around the wound and the knee just seems to stick. Looking at the markers on the rom brace its pointing to between the 75 and 90 degrees. Just looking for any advice on how to improve the rom as i really want to get moving! I am doing heel slides on the floor. Sitting on the chair using gravity and trying to push the knee back. Do you have any pearls of wisdom? I have been moving around home on one crutch and aiming to get comfy so i can lose them,lol. The leg still feels wea although a bit of improvement but not enough forme,lol. My leg/knee all feels very solid to the touch and still i have a lot of bruising coming out. Right now the back of my knee is black! I have some bruising going up the leg and around the kneecap. I thought that would all be gone by now! I tried icing last night and it helped the swelling a bit. Just feel like i am at an inbetween stage if you get me. I am off to Florida in 14 weeks and a bit worried now abouthow able i will be. Anmy advice you could give me?

Glad your doing good again and hope you are ok after your bike ride.

Wondr how Jumpi5d is doing. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 06, 2009, 08:25:03 PM
Hi chereb,

I totally understand what you mean about the in between stage.  I just went through my blog around day 50 to remind myself what I was going through then and I had one entry dedicated to this feeling. I am coming up on 13 weeks right now and I think a trip to Florida would be great.  So, I think you will be fine to go to Florida in 14 weeks from today (putting you at 18 weeks postop right?). But, you do need to get your ROM better before you start doing any significant walking and therapy.  And, the more time that passes, the harder it will be to get so just get it over with I suppose.

I can give you a bunch of the exercises or positions I put myself in to get ROM but no matter where or how you do it, it just ends up being pain tolerance. This is probably not what you wanted to hear but it is true.  There isn't one degree of flexion that I got that didn't hurt like crazy. But, the good news is that once you put yourself through the pain to get the degrees, you don't lose them and they get easier to get and not even nearly as painful. So, once you get to 90 degrees, you have it and it wont ever hurt that bad to get again. Also, my advice is to get someone to help you, the more unfamiliar the better but a friend, husband, child can all do it.  The reason for getting help is that I don't believe a person is capable of inflicting enough pain on themselves to get the ROM.  I know I would not have gotten my last 10 degrees without my boyfriend and PT pushing it there. Just go slowly and remember to breathe.

The best success I had was to push flexion for about 15 seconds pretty hard and then slowly let up and rest for 10-20 seconds and then do it again.  Each push should get you at least one more degree of flexion than you got in the last push. Once you get it, hold it for a few seconds and then either push for another degree or two or release it. Here are some positions or ways to do it yourself:

Sit on the floor or couch with a towel or belt or rope looped around your ankle and do heel slides using the belt to pull your heel closer.  Mark where your heel got last time, straighten and go further the next time.

Lie on your back with your feet up in the air so your legs are perpendicular to your body.  Bend your legs at the knee and let gravity pull your heel toward the floor. You can rest your good leg on your surgery leg for additional downward weight and pressure.  A towel or belt looped around the ankle and pulled by your hands will also do the trick.  When you have had enough straighten the leg, rest and repeat.  It is also a good quad exercise to try and straighten the surgery leg without help.  Hurts like hell at first but keep going. If this is too intense at first you can do it next to a wall with your heel on the wall.  The friction between your heel and the wall will slow the downward movement.

Lie on your stomach and loop a belt or rope around your ankle (it will need to be long enough to reach over your shoulder to your hand).  Pull the rope so that your knee bends.  Goal is to get your heel to your butt over time.  This is the hardest and most painful angle to get. But, once you get it, you have full ROM.  Hooray!

Once you get 100 degrees + of flexion you can then try to sit on your heels.  Kneel down with both knees on the floor and slowly lower your butt to your heels. You can use your quads or your hands to control the speed and weight that falls. 

These are the ones that worked best for me. There really is no secret exercise or method to getting flexion, just sweat and tears.... but, it is so important to your recovery and so worth it. You will begin to feel much better once you get your flexion back.  Also, I don't know much about your bruising.  I really didn't have much bruising. Make sure you are elevating your leg when you ice so the blood doesn't pool and the more you can bend it and straighten the more blood flow you will stimulate. Has your PT said anything about it?  I do remember a little bruising and pain behind my knee for a while but it goes away in time.  Good luck to you, keep up the hard work and remember the pain is temporary and will actually make you feel better over time. Hope this helped.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 06, 2009, 11:48:54 PM
Well, now that I'm just 2+ weeks away from my surgery I'm starting to have second thoughts  :o  This seems to require much more recovery than I had expected.  Do I really need to put myself through this now??  One thing I don't think I've mentioned is I'm 47 years old.  Yes, I've been told by a Dr. that I need this but do I need it now?  I'm not in constant pain.  Don't get me wrong, it does hurt me, typically more after higher impact activity than say biking.  Even walking at the zoo for a day bothers me for days afterwards.  Chereb, based on what you have written it sounds like you were in bad shape.  Aturpin, I think your injury was similar to what I've got going on but did it keep you from doing what you like to do activity wise?  Mine has kept me from running, which initially (3 years ago) really bothered me but now I've filled my workouts in other ways.  I always know that knee is different but not ALWAYS painful.   Any thoughts would be appreciated.
Thank you for the advice about going back to work.  My part time days will be about 4 hours, no more. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 07, 2009, 02:47:04 AM
Hi KCuman,

Not surprisingly, I ahd the same sentiments you are having about whether or not I really needed to have the procedure.  Prior to surgery I wasn't having any notable symptoms.  Like you, if I went for a good hike or golfing (walking not riding) I would feel pretty achy but I could cycle and swim and I had already committed to giving up running.  I decided to pull the trigger on the surgery for a few main reasons. I am 27 years old and I am not even close to being eligible for a TKR. The longer I waited to have it, the more cartilage damage I was doing.  I wanted to try to preserve as much of my existing cartilage as possible by taking the pressure off of my lateral compartment. I knew I was going to have it at some point so I figured get it over with and Im not getting any younger. You may want to ask Dr. Bugbee if you are ultimately going to be looking at a TKR in your lifetime.  If yes, then you may just want to hang on as long as you can, skip the osteotomy and get the replacement.  However, if you have a TKR at 50, you will likely need 2 at the minimum assuming you live a normal lifespan. If you have the osteotomy, you may be able to put of a TKR til you are 60 or maybe older.  Then you may only need 1 TKR or none if you are lucky. I think, if given the choice, I would rather have a big knee surgery at 47 and 65 (estimates) than at 65 and 75. If this is something you think will or could make your life better in the long term, you should just go for it... its only a few months, in the grand scheme of things, what's 3 months? Good luck with this choice. Its not easy that's for sure.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 07, 2009, 02:49:58 AM
Post Op Day 90 (March 6th) - Quick update after my first day back at rehab yesterday.  Knee is doing great.  I woke up not sure what to expect since I had an hour bike ride + therapy yesterday and the knee held up great.  Good enough that I went for another hour bike ride today.  Knock on wood but it looks like I have conquered my plateau and I am hoping to see some good gains in the coming weeks.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on March 07, 2009, 05:02:26 AM
Heyyyy I just thought I'd leave you guys an update. I'll start my own diary when I get home. Excuse the typo's I'm still on hospital meds..haha.

 Surgery went amazing. I ended up having a opening wedge ostoeomty instead of the closed wedge. I have a plate and 5 screws. Surgery lasted 5 1/2 hours!!! My incision is about 9 inches long down the lateral side of my leg.  I'm doing amazing. I woke up from surgery and I wanted food and I've been able to eat and drink since. I've had very little pain medicine. I have toradol every 6-7 hours then I've taken norco as needed. I can take 2 of those every 4-5 hours and I'm taking one every 6.  I'm in a CPM and I've made it to 70 degrees in it. I can sit in a chair though with my feet flat on the floor. I think my biggest accomplishment was that I made it down the hall and back on crutches and that I can do a straight leg raise! Didn't expect to be doing any of this on the first day after surgery. I'm toe touch weight until my 2 week appointment where if things are going good I'll be weight baring as tolerated. Everyone here at the hospital has been amazed at how much I'm doing already. (I am too....)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 07, 2009, 09:48:44 AM
Atpurin, Many thanks for the heads up on the excercises. They are a little bit different than what i am doing and will be giving them a go. Will let you know how i get on with them. :) Sounds like you are coming along nicely . I will be 20 weeks post op when we go on holiday. Just worrying about the 9 hour flight in a plane seat! Once i get there i will be fine. Lying by the pool in the sun is what keeps me going just now!! I have a lot of muscle aches today mainly due to me taking a few unaided teps,lol. The top of my thigh feels it toady, but thats good because it shows im waking up the muscle. Thanks for taking the time to write down the excersises for me. Really appreciated. :)

Hi KCuman, Like Aturpin says i think we all have the same reservaions. I was advised to have this op 2 years ago and it took me until a few months ago to commit! I had to weigh up all the pros and cons and decide what suited my lifestyle. My youngest is just 4 and i knew this would hae a huge impact on family life. If i had opted for the TKR i would have worn it out in prob 7 years so mid 40s i would need another, 50s another ect. My OS told me eventually  the bones would be to fragile to do another and then your option is fusing the leg or wheelchair. Even though i am still in the early stages of recovery i dont regret it for a minute. Its hard but worth it. I need to have the same op on my left leg as athritis has broke my cartilage down to the bone there too. I have not been put off and honestly have no athritic pain since the op. I know at some point i will need the tkr. Os said i could get 1 year or 15 from this op but the longer i get the better for me. Good luck its not an easy descision.

Hi Paige,

Good to hear from you. You sound as if you are doing great. Did you go for the nerve block? Good to see you are working out already. Take care.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on March 07, 2009, 05:01:02 PM
Cherb I had an epidural that was done before surgery then I was just given medicine so I'd sleep through it instead of being under general.  Things are going awesome. I accomplished the stairs today! Meds are keeping me super sleepy though.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 11, 2009, 07:30:02 PM
Post-Op Day 95 (Wednesday, March 11th) - My knee continues to do well.  On Sunday I rode my bike to the gym, did some therapy and weight lifting, and rode back.  This is the same thing that I did last time that really fired it up.  I guess I am a slow learner or refuse to go down, whatever you like to call it.  This time my knee swelled up again but not as bad.  It was tight and swollen enough to keep me from working out on Monday though. I am glad I listened to my knee and took Monday off, last time I didn't do that and it snowballed into a big mess. I learned that sometimes 1 day of working out can cost you 4 if you do too much. Tuesday I was able to get back on the bike and did an hour of spinning. My knee was a little tired afterward but is good today.  I was running errands the other day and I couldn't help but notice how comfortable I am when I am walking now. This has been good progress. I would still like to see improvement in other activities of daily living like going up and down steps (this has been improving slowly though), bending down to pick something up, moving right to left, and carrying heavy or bulky items. I would like to spend time working on these things but still feel somewhat limited by the capabilities and endurance of my knee.  It doesn't take much to fire it up so I can only do 5-6 exercises each day... this is on top of cycling or swimming for 30-60 minutes. My cycling has improved as well.  I have to concentrate to make sure that my surgery leg is doing its share of the work but I have noticed more comfort coming out of the saddle and am able to exert more force through the pedal. Conversely, cycling is helping me get good strength gains as well.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on March 13, 2009, 11:10:09 AM

I'm glad to hear you are mostly back on track. The main value of this diary for me is seeing your progress over time and remembering that you can't just get stuck on any one day in the 6-9 month rehab and recovery phase. You have peaks and valeys and sometimes it's two steps forward, one step back. You are generally improving week over week and you don't even have all of the cushiony parts of your knee yet!

Curious whether you needed to adjust your road bike position to accomodate your newly straightened leg. Also, do you ride clipless pedals and, if so, how well does your leg tolerate the torque of twisting in and out of the pedal?

I think about my upcoming surgery every day and mostly wish it was just over and I am into rehab. Oh well.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 13, 2009, 05:34:20 PM
Hi Tailwind,

Thanks for your encouragement. I may be back on track now but I think we all know that I will fall off track again, that is the nature of these procedures and rehabs. And that, for me, was the main point of writing this diary.  So people can see what I did to get off track, when and at what stage of recovery I did it, how I got it back on track, etc. When contemplating and preparing for the surgery I was looking for something like that; I am the kind of person who wants to know everything thats in store for me. I hope my experience can provide insights into you and your rehab experience.

To your question about my road bike, I am not clipping in yet so I can't report about the torque.  I am relatively new to road biking and don't want to risk a fall especially with my leg the way it is, I don't need more troubles.  I do, however golf, and the torque in the swing is a similar movement to getting in and out of the clips times 5.  I haven't picked up my clubs yet but think I might this weekend.  I will report back on how my knee handles that.  Just speculating about the clips, I think the movement would be okay because you don't have to rotate too far and you can get in without putting your whole body weight on the pedals.

Also, no, I did not have to adjust the position of my bike to accommodate my leg.  Granted I am not that particular about my settings since my road riding is still in relative infancy.  One thing I am really surprised about this surgery is how little I have had to change.  I thought everything would feel different or weird and that it would feel like a new leg or prosthesis almost.  Truth is, it feels the same but with less pressure on my lateral compartment. Walking feels the same (although I have been told I no longer pronate, which makes sense since my angles are all corrected), cycling feels the same, clothes fit the same, everything is the same.

I know how you feel about the anticipation before surgery and how bad you just want to get it over with.  Try to enjoy the time you have now and prepare the best you can for your upcoming immobility and it will come up faster than you expect. Try not to worry, its a waste of time.  Everything will be fine.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 13, 2009, 06:02:13 PM
Post-Op Day 97 (Friday, March 13th) - Yesterday I completed my first all-out 60 minute spin class.  I have taken a couple of spin classes up to this point, namely the class I took the day my Dr. told me I could walk.  But, in those classes I have had to make adjustments like staying in the saddle, leaving early, or taking off some resistance.  This time, I did everything and felt pretty good about it.  My knee and leg felt pretty strong, maybe 80% of the right leg. I could feel pretty solid fatigue in both legs by the end and the surgery leg was biting a little bit at about 40 mins but it never escalated. The repercussions have been minimal, a little soreness, a little achiness, almost no swelling.  In the past, this kind of activity would have resulted in significant swelling and discomfort.  I am pleased with this result.

I also did yoga yesterday (about 30 minutes) and I have to report that yoga is great for ROM.  When I first start I am tight in my surgery leg, my the middle, both legs feel the same. I would recommend yoga for anyone 10 weeks+ post-op especially those struggling with flexion

I have a guilty confession:  I was looking at my new leg in the mirror the other day and I really like the way it looks.  I feel like I have had plastic surgery in a way.  My leg is straight like the majority of the population and it makes my muscles look more tone and stronger. If there is a silver lining for anyone who is considering this procedure, it could be the improvement in appearance.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 14, 2009, 12:06:09 AM
Hi everyone,

I just wanted to report that I had my exploratory scope today, which went really well. It's the "easiest" surgery/recovery of all the ones I've had. Right now I only have some gauze/padding with an ace wrap that goes from mid shin to lower thigh, I barely have any pain, and I'm allowed to weight bear as much as tolerated. Although this time my stomach felt very naseous in the car on the way home, which I think may be partly because I had a longer car ride than normal (a little over an hour vs. 5 minutes). My past surgeries have included full leg wraps with aces and immobilizers, the pain was fairly intense, and I was on crutches and could only toe touch weight bear for 4-6 weeks. In comparison, I barely feel like I've even had surgery.

So I find out more at my post-op appointment Wednesday, but I saw my doc right after surgery and he said that he took the cartilage biopsy and I will be having the ACI (autologous cartilage implantation) with my DFO, not the meniscus transplant. This is what I was hoping for, since now I can do the surgery on MY time once the biopsy is grown and I don't have to wait for a meniscus to become available.

I can't wait to shower on Sunday and take the wrap off. If I'm not limping and feel pretty good I'm also able to ditch the crutches then, too. I also can't wait to get back to working out and getting strong and hopefully losing some weight before my next (and hopefully final) surgery. I feel like I'm getting closer and closer to "the big day" where I can finally get the surgery over with and start down the long road of recovery and feel like I'm on the upswing of having a pain-free knee!

Glad to hear everyone else is doing well...congratulations aturpin on completing a 60-minute spin class! :) 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 14, 2009, 04:17:10 PM
Aurpin....Excuse my ignorance here but what is a spin class?
Well certainly seem to be doing great. Like you i admire my new straight leg although its not quite normal looking yet,lol.

Nikkiluv..Glad the scope went well for you and you can look forward to getting the surgery over with now.

I am now 8 weeks post op and a bit down in the dumps. Nothing seems to be moving at all. I had some physio yesterday and my ROM is only 65 degrees. PT say i am making progress and use the patience word again! A word i am getting fed up with now,lol
The medial side of my knee is so painful its a struggle to crutch with weight on it. I am assured that once all the particles break down it will get less painful. I am officialy allowed to one crutch! It seems that because of the cast i have weight transference problems so its back to basics for learning to walk. I am going to work work work for the next 2 weeks as i really want to walk again!
Hope everyone is doing well.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 14, 2009, 05:06:56 PM

Sorry to hear that recovery is going slower than you'd like, but getting down to one crutch is promising! At least you'll have one hand free which will hopefully make getting around a bit easier. I will keep you in my thoughts and hope that you make the progress you are hoping over the next couple of weeks!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 15, 2009, 08:50:41 PM
Hi Chereb,

Apologies for being unclear on my gym rat lingo.  Spin class is indoor cycling.  The bikes are stationary and allow you to apply your own resistance on the wheel to simulate hill climbs, sprints, intervals, etc.  The class can be as intense as you make it since you are in charge of your own resistance.  However, it is typically pretty challenging and long (60 mins) and combines seated and standing climbing and sprinting. Once I was told running was no longer an option I turned to spinning as it is one of the only exercises that meets the intensity of running for me.

I am sorry to hear about your frustrations with ROM.  Patience is key because it frustration usually doesn't do much by way of helping. But, hearing "be patient" can be infuriating when all you want to do is scream and complain. Hang in there and keep pushing (literally) hard and often, you will get there.  One thing I forgot to mention that I used to do for flexion is the recumbent bike. That't the bike that is kind of like sitting on the couch with your feet up.  You can adjust the seat depending on what range of motion you are at...the less flexion you have, the further back you put the seat.  As you get better, you can move the seat up. It was a good exercise because you move it yourself and you can use the good leg to turn the pedals until you bad leg warms up.  Once you warm up the joint with blood flow then flexion seems to come a bit easier. Also, you get the secondary effect of quad exercise.

As for your medial joint pain, I had the same thing.  It was so painful that my knee would give out.  It lasted about a week or two for me and then subsided.  But, for the two weeks I didn't put much weight on it and once the pain went away I started putting progressively more weight on it and never felt the pain again.

Keep your head up, it will get better, it always does.


Congrats on your scope.  It must be nice to have a clear path now.  Good luck preparing as you move towards your surgery.  Enjoy your time now and take advantage of it.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 16, 2009, 02:40:47 AM
Thanks aturpin. I was able to take a shower and take the dressing off today, but it's pretty swollen and warm to the touch. I'm barely able to flex my knee right now because of the swelling restricting it but I'm trying as much as possible. I have a decent amount of pain coming from the incision sites which makes things uncomfortable. I'm not able to ditch the crutches yet (I'm down to just one though) because I'm trying not to push my body too much and I don't want to make the swelling any worse. I've been icing and taking ibuprofen on a pretty steady schedule.

I'm hoping that most of this is maybe just from the trauma of the scope and the biopsy. Aturpin, chereb, and others...was the recovery from your biopsy scope different from other scopes you may have had? My past scopes I had been on crutches for so long that the walking came a bit easier and I wasn't really too swollen following surgery and was able to get my ROM back pretty easily. Thanks in advance for your help :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 16, 2009, 04:31:35 PM

I didn't have a biopsy or scope but I did have a scope before my surgery where they trimmed my meniscus and cleaned out some scar tissue.  I remember walking out of the hospital and most of the day. However, I do remember going to breakfast afterwards on crutches and having to pretty solid soreness. I also remember soreness, moderate swelling and I think it took me 3 weeks to feel 100%.  I did notice a very small amount of muscle atrophy after the scope but it all came back quickly (then I complete obliterated it w the osteotomy so I guess that really doesnt matter). I remember doing a bit too much after the scope and then elevating and icing.  This was my only scope so I have no frame of reference to say if it was better or worse than others. Take it easy for a day or two more and I bet you'll be back in business.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 16, 2009, 08:57:43 PM
Oops! Thanks for your reply, aturpin. I forgot that you guys have had just osteotomies and not ACIs as well. Today is a much better day than yesterday. I ditched the crutches today and feel pretty good. I'm a bit unsteady and slow as I'm sure the swelling is inhibiting my muscles from working, but overall I'm walking pretty good and barely have pain. I've been icing and elevating like crazy, and I believe the swelling is down some from yesterday since I'm able to flex it easier and a little further than yesterday. I was even able to take a shower all by myself today! (A feat that no one else understands how big it really is unless they've had knee surgery themselves and been so dependant on others). Hopefully my recovery will continue on the upswing and I'll be back in business soon.

Thanks again :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 19, 2009, 06:23:14 PM
Just a quick update....I had my pre-op appointment last week and had full leg x-rays for the first time.  I found out my left (bad) leg is collapsing on the lateral side due to my running collision a few years ago and my angle is 7 degrees.  Based on what I've read here that does not seem as major as some.  I have decided to go ahead with my surgery on Monday the 23rd (in 3 days!! :o ).  Like I had said a few weeks ago I have good and bad days with pain.  Recently my back has felt all out of wack and my PT thinks it is due to my leg problem.
Auturpin, I'm glad to hear you are doing full spin classes.  I look forward to being able to get to those classes and hope I can give it a go at 10 weeks. 
Tailwind, like you had said, this has been great to go and look back at progress at various time periods to see who is experiencing what.
While I was at my pre-op I did ask the "fellow" Dr. that was going over the risks and what to expect with me how long he expects I will be non weight bearing and he said SIX weeks.  I really hope that is all but realize I should not push it.
Thanks again and I'll be in touch late next week. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 19, 2009, 07:29:24 PM

Congrats on making the decision and pulling the trigger on your surgery.  We all know it isn't an easy decision to make and difficult to inflict on yourself. At least your date is coming up quickly and you wont have too much anticipation. If I remember correctly, we have the same doctor so I am pretty sure we probably met with the same fellow Dr. during our pre-op appointment.  I remember him telling me no weight bearing for 6 weeks but it did end up being about 10 weeks.  I hope you do get to walk in 6 weeks but wanted you to know that it could be 10 so you aren't as disappointed as I was when I learned I would have 4 weeks longer than anticipated. I left my appointment at 10 weeks w. the go ahead to walk and went right to spin class so I think your expectation of spin at 10 weeks is definitely doable.  Just go slow, it takes time to get the strength needed for out of the saddle work and climbing. First things first, good luck on your surgery and congrats and getting that much closer to better. I am sure you will do great!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 19, 2009, 07:46:46 PM
Post-Op Day 103 (March 19th, 2009)  - I am two days short of 16 weeks post-op (3 months and 2 weeks)... I can't believe how much time has passed since surgery. I had a big day yesterday, I golfed!  To be clear, I went to the range and hit balls, I didn't actually play a full round.  Nevertheless, I did full swings and my knee held up great.  There was no knee pain and almost no soreness.  I have had much more soreness after doing standard rehab exercises than I have after playing golf. In fact, I was feeling good enough to go and do an hour yoga class this morning.  I might even venture to say that I felt better after golfing now than I did after golfing pre-op.  I definitely felt less weight on the lateral side of my knee during my swing and less grinding. I have to say that this is the first thing I have done post-op that felt better than it did pre-op.

Most everything else I am doing now I either am lacking some strength, am not yet back to doing, or didn't have any problem with pre-op so it is hard to gauge if this surgery has been effective. But so far, I think the surgery has made my golf swing more comfortable. I look forward to hiking because that is something that bothered me pre-op and I want to see if it willl be better post-op.  However, I am not ready for that yet.  I am noticing that I am still having some problems walking down inclines and going down steps, I certainly don't think hiking is a good idea at this point.

I am noticing that I am getting mass and muscle tone back but I am still lacking functional strength. What I mean is that I am still compensating during activities of daily living... the simple things.  When I walk down a small incline I notice my surgery leg is weaker and not capable of normal walking.  If I really concentrate and force it, I can get it close to normal, but, I notice the knee feels weird, not painful but not great. The same is true for going down stairs and bending over.  These are the most pronounced things.  I notice when I bend over I put all of my weight on my right leg and bend down. I am trying to make a concerted effort to do these activities with just my left leg.  This has been a small source of frustration for me but I will continue to work at it.

For now, I am grateful that I can add one more activity back into my life.  That's progress folks... I'll take it!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 20, 2009, 11:24:43 AM
KCuman- Good luck on Monday :) Im sure you will be fine.

Aturpin-  You are doing so good...wish i was half way there with you,lol.

I am 10 weeks post op. Yesterday was horrendous....think I overdone the physio quite a bit and suffered a LOT of pain for the rest of the day. Aturpin I have been doing the Rom you suggested and seems to be getting a bit better day by day. I can shuffle around without crutch at home now and it seems to be getting a bit better (easier). Hopefully I will be able to walk soon. I am trying so hard and I can only do my best. After all the pain yesterday it seems to have settled down and strangely my leg feels a litle more stronger today. I am not going to overdo the physio again. Just breaking into little setions throughout the day. Take care everyone and have a good weekend. :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on March 22, 2009, 04:30:25 AM
I'm glad everyone is doing okay. Sorry I've been MIA. I made it to two weeks wooohooo. I'm doing okay, swelling has gone down a lot and my pain is pretty much non existent unless I over do it. I guess its just a waiting game now. I'm on crutches until atleast May 5th. (8 weeks to the day.) I can put 20-30lbs on it but no more except in the pool.

KCuman-Mine was at 7 degrees. It's enough to make a HUGE difference.

aturpin- I'm sooo glad that everything is going good. I can't wait to be back doing things again.

(I hope you don't mind if I post this here I thought everyone would enjoy it. I'll take it down if you don't want it up.)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 27, 2009, 03:18:03 PM
Hi everyone,

I posted a thread under the ACI section, but I've been in contact with people on this thread so I thought I'd share the good news on here as well. A lady that I have been dealing with my case at US Bioservices (with Genzyme) called me today to let me know that my insurance has approved my ACI!! I'm absolutely on cloud 9 right now. The lady called me last Friday to let me know that she needed additional information from me. I sent it to her on Monday, and when I called to verify she received it on Tuesday, she told me that I had a couple things going against me. For one, I had not had microfracture before, which many insurance companies prefer you have prior to ACI because it's apparently "more conservative." My defect is on my tibial plateau, which is an "off-policy" area for ACI, which meant they may or may not cover it. However, when I called my doctor's office the administrative assistant believed I had a really good chance for approval. None the less both my doctor's office and Genzyme sent everything they could to my insurance company along with their fingers crossed.

I was actually with my dad and he was driving around with me and we were running errands. I originally forgot to bring my cell phone and was upset because I've been glued to that thing on pins and needles waiting for an approval. We ended up stopping home really quick before going out of state, and low and behold not even 5 minutes after getting my cell phone I got the call saying I was approved. I  just started bawling and I was shaking (good thing he was driving). I seriously confirmed it with the lady like 5 times stating, "so you said I'm approved, I'm approved right?" I got off the phone and could barely get the words out to tell my dad, and then called my mom at work. When I got a hold of her I started to cry and she thought something was seriously wrong, but once I got the words out she said I better stop crying because she was going to cry too. I was in shock and don't think I believed things went so well, especially after hearing some horror stories on here. I guess just keeping the faith and a positive attitude that things would work for the best really helped.

I will also be having a DFO with my ACI, however the ACI part was what I was waiting to hear back about for approval. I still can't believe how quickly everything happened. I had my biopsy on March 13th, and I heard back today that I was approved...less than 2 weeks! II've heard many horror stories how people wait months and have to go through many appeals). Now I'm just waiting for all of the papers to go through and my doctor's office to contact me to start scheduling everything (along with my cells to finish growing). I look forward to updating everyone soon as to when I finally have a surgery date and then also posting a diary. Thank you to everyone for all the help and support I've received on here, it's really been awesome!!!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 28, 2009, 10:29:42 PM
Jumpi5d..nice xray. How are you doing?

Nikkiluv..Glad you have your insurance sorted and can get a date for surgery now.

Well i made an error last time i posted as i am only 10 weeks post op thisweek,lol. I am still strugging to walk and doing physio religously. Went back to PT yesterday and had a deep tissue massage. Was quite uncomfortable especially the wound area. Last night it was pretty red and sore and still pretty sore today. It seems my muscles† are very tight so this is to help. I have gained a little ROM. Last time i was 65 degrees and now just under 90 degrees. So getting there slowly. Its 11 weeks until my holidays and i am pushing myself for that. Just not going quick enough. I go back to see my OS on the 6th April and will see what he says. PT was pretty pleased with progress and is confident once the activation of the muscles that wont do squat at the mo happens everything will come together. Anyway I am off to do my physio for the last time today. Hope you are all well.†
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 29, 2009, 05:18:04 PM
Just wanted to check in, Iím at day 7 and feeling better than I thought I would for the most part.  I had the DFO and scope, to take a look at my damaged AC on the tibiae plateau, on the 23rd and immediately after surgery (3pm) was fitted with a fell leg brace (lots of Velcro) with the knee hinge open for full ROM.  No food that day but didnít feel like eating, ice cubes were enough.  BTW, I did come to with a catheter, didnít discuss this with the doc in advance but after hearing the struggles of my roommate with a bedpan am glad I had one and it was only for about 24 hours.  I did find, and still do, the hip area where they took the bone graph pretty painful when I tried to adjust my positon in bed and do still feel I came home on day 3 and have been only taking Tylenol and ibuprofen for pain and swelling.  I was prescribed perkoset and have it just in case I feel more pain but have not used it.  The pain meds really made my head feel weird so Iím trying to stay away from them.   PT came to the house on day 4 and my range of motion was at about 65 degrees and I can pretty much straighten it out.  Since then I think I can get to 90 degrees ROM if I sit at a bar stool and just let my leg hang for awhile.  Yesterday, day 6, I went for a ride in the car for a couple hours while my family ran errands, and then later that day went out for dinner.  No problems sitting for an hour in a chair, I do feel pain the first several minutes when I go from sitting to standing upright though but that quickly subsides.  No additional drugs at night, I do wake up a couple times when Iím trying to roll over and adjust the pillow between my knees. 
Thatís it for now, Iíll be in touch. 
Iím glad to hear everyone is making progress, some slower than we would like but it is progress!! 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lea50 on March 29, 2009, 06:28:17 PM
Hello everyone,

This is a great diary  ;D.  Thank you Aturpin for starting it.  I enjoyed reading about your progress.  It nice to read about positive results.

I will be having a TTT along with a patellofemoral replacement, lateral release and a VMO advancement.  No surgery date yet.  Is a TTT similar to a DFO?  All these adreviations are very confusing.

My injury is work related so the approval for the surgery might take awhile.  I will continue to keep up with everyone's progress on this post while I'm waiting.

Have a good day.  I hope everyones knees continue to improve.


Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on March 31, 2009, 04:49:41 AM
Hi everyone!

So there's a bit of good and bad news for the day. The bad news: I didn't end up getting my unloader brace today. Turns out I drove a half hour to change into my shorts to get fitted only for them to tell me they ordered the wrong brace. I was pretty upset as I was looking forward to getting it, especially since today and Wednesday are my days off so I was hoping to wear it the most on those days to wean myself into it. They're putting a rush on it so they'll have it Thursday and they said no matter what they'll fit me in that day as well. I'm just frusterated because they called me Thursday to make my appointment to get it...I would've figured 3 days would've been enough time for SOMEONE to have figured out it wasn't the right brace! Oh well, like my mom said if that's the "worst thing" that's happened so far along this journey then things overall things are still going really really well. She's right, I can't complain too much.

However, the good news: I have a surgery date!!!  Offically 7 weeks from today...May 18th. I wanted it to be the first week of May, but both the first week and second week are already booked so the first available date in May was the 18th. She said I could've done it April 20/21 or April 27/28, but my parents are going on vacation the week of April 25th-May 2nd so clearly neither of those days would've worked. It's okay anyways though because the more I thought about things the better it is for me because I'll have more time to physically prepare myself (gotta build up all the muscles I can, hopefully lose a few more pounds), and hopefully take some vacation time (at my work vacation time is based on your hire date, and my hire date is the end of May so I have to use at least one week's work of vaca so I don't lose it before my surgery!!).

Hope everyone else is progressing along in their rehab and doing well!!! :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 31, 2009, 06:04:37 AM
My sincerest apologies for being a no show over the past week and a half or so.  Everyone sounds like they are progressing so well, it is great to hear. 

KCuman - I cant believe you had your surgery already!  Dr. Bugbee got you in quick.  You are doing so great.  I can't believe you can sit in the car and at dinner at just one week post-op. You are handling your pain amazingly.

Chereb- Glad to hear you are making progress on your flexion, it must be such a nice break through to see 25 degrees of flexion in a matter of a week or two.  Great work!

Jumpi5d - Thanks for posting your xray, it was great to see another leg that mirrors mine.  I havent been able to access the pics I have for mine so it is nice to have yours.  Great job on your progress too, you are coming along great.

Lea - Glad you are enjoying the diary :). I believe a TTT is pretty similar procedure.  I read a lot of information about tibial osteotomies prior to my surgery since there wasnt a lot of DFO info available and I found the comments and experiences to be very similar to mine. It sounds like you are having a lot done . Good luck!

Nikkiluv - Congrats on your surgery date!  The preparation begins! The more you do now the better you will be on the back side.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on March 31, 2009, 06:32:53 AM
Post Op Day 114 (March 30, 2009) - I am coming up on four months post-op, my how the time flies!  I attended another rehab session last week and got the ok on my progress from my therapist.  No complications, no red flags, full speed ahead. I went mountain bike riding for the first time a couple of days ago. My knee did really well on the climbs but I noticed myself compensating a little on the way down.  There were also some sections where I had to get off the bike and hike a little bit, my knee didnt really like this, especially on the downhill. The biggest obstacle I am looking to overcome right now is compensation.  I am continuing to focus on not compensating but it is a work in progress. Aside from compensating, especially walking downhill and going down steps, I am pretty much back to normal.  I got a new job and started today and wore high heels.  The knee did pretty well with them, better than at the wedding a couple of weeks ago. That is a theme I am noticing most these days, that I am capable of doing more and more without some of the swelling and achiness that I used to get. I am starting to look forward to my next surgery as I am really feeling the cartilage defect on my lateral condyle despite the osteotomy. I cannot wait for this to be all done but so far, so good.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on March 31, 2009, 01:18:01 PM
Atupin, Im so jealous,lol. My dream is to one day wear a pair of heels!  :)

I have a question for those of you who have had the op. Have any of you experienced weight loss? I have lost 14lbs since the op despite eating normally and sometimes more that previous.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on March 31, 2009, 10:53:57 PM
Hi All,
Aturpin Iím so jealous that you are out mountain biking, I look forward to getting back to my activities.  Good for you!!  I actually had my surgery date with Dr. Bugbee for 2 months, just didnít jump into this chat site until recently.  Iím happy with my progress so far but may have overdone things yesterday by going to a warehouse type market and sitting in a wheelchair for an hour getting pushed around the warehouse type store.  My knee was pretty stiff after being in one position for that long.  Ice at home did wonders for me.  Ice is my friend right now.

I have a question about outpatient PTÖ.have you all worn your brace during PT?  I feel as though my brace inhibits how much I can bend my knee (is that flexation or ROM?  Donít have the lingo yet).  OR, maybe my knee is that swollen that I canít bend it anymore.

Chereb, I hear you on the heels, even just a couple inches will be nice   And I havenít been on the scale in the last week so donít really know about the weight lose.  Maybe it is a loss of muscle and therefore weighs less.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on April 01, 2009, 04:09:44 AM
Hi KCuman,

Here's a little info to hopefully help with your lingo:

Flexion is when you bend your knee
Extension is when you are straightening your knee
ROM is range of motion and it's the distance you're able to achieve between flexion and extension

Hope it makes things a bit easier for you to understand. I'm only so comfortable with it all because I graduated with a degree in Exercise and Sports Sciences and spent four years of my life engulfed in these terms, hehe :)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 01, 2009, 01:45:59 PM
KCuman...I raised the very issue of the brace inhibiting my movement as i felt it was holding me back. I prevously was held back with the cast as the hinges had slipped down preventing knee bends. So when i was switched to the brace at six weeks it was the first thing i brought up at physio. My PT takes my brace off and i do all my workouts at home minus the brace too. It works much better. At 8 weeks post op i stopped wearing it altogether. I must say i have not been given the ok from the OS to do this but i felt it was inhibiting my walking ect. I have come on a lot better since then and managed to get from a stagnant 65 degrees rom to just under 90 degrees in the two weeks. Good luck with the PT.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on April 02, 2009, 06:15:37 AM
Heyy. Sorry I've been sooo stinking busy(crutches and all!) I'm glad you guys liked the x-ray. I was sooo surprised by how much metal was there!  It's crazy reading this post how completely different each doctor's post op is done. I've never been in a cast or brace, I was in CPM right after surgery set to 60 degrees and it was upped to 75 before I left the hospital (could have went a little more but it was starting to hurt.) It's been 3 almost 4 weeks since I had my surgery and I feel like I could get up and walk across the room. My ROM isn't where I want to be but its not horrible. I seem pretty well stuck at 0-90. I've been trying to ride the bike for 15-20 minutes (5 minute intervals) a day but I think I may have been doing to much. On top of all that we've been traveling about every weekend since the surgery (not sure how that all got scheduled that way but it worked out.) I'm trying to take it easy for the next few days and see how it goes.  I've noticed that I've been sleeping WAYYYYY to much. I'm sure its just my body healing but it's crazy. I was used to 5-6 hours a night and now if I don't get like 12 I can't function.

chereb. I've lost a little weight but not a lot I just blamed it on being on crutches It is a LOT of work I don't care who says its not and I'm even allowed to put some weight on my leg!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 02, 2009, 03:09:13 PM
Guys, Right now i feel like crying. The medial pain does not seem to be easing and it does not matter what i do. Its stopping me getting full weight through the knee as its absolutely agony. I keep trying and trying. Everything else seems to be going well and healing ok. The muscles are coming nicely but i am afraid that something is wrong. Something does not feel right with this medial pain. It feels like bone pain so not muscular or scar tissue pain. Im sure we are all aware of the difference between them. It feels like the athritic bone on bone pain but worse. 
I feel i have reached a point of despair and worried that i am never going to walk. Every time the slightest bit of weight goes through the medial side of my knee its the same. I have tried working through it despite the pain and still its there. I dont want to tell my husband as he wasnt that keen on me having the op and i cant be bothered with told you so just now. I feel bad enough. Only those of you who live with athritis everyday will get how it is. The PT said the problem was the hip but i feel fine in that dept. Its the knee thats the problem. Anyway I see my OS on Monday so will wait and see what he says.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on April 03, 2009, 12:20:55 AM
Chereb, sorry to hear you are experiencing so much pain.  I know you had said you had not been wearing your brace all the time although your OS still wanted you in it.  Does the pain level change with or without the brace?  Try not to stress that you made a mistake by doing the DFO.  You can't change that now.  Hopefully your OS will have some good information/answers for you on Monday to help you through this.


Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 03, 2009, 12:37:40 AM
Hi, Have spent the whole day braced up and only removed it for ROM. It made no difference to the medial pain. I have completely rested it for a few hours and the pain has eased a little. This only comes on when i try to put weight on it and always the medial side. It has been like this since surgery and it does not seem to be getting any less. Thats whats worrying me. I dont know whether to try and push through no matter how painful or leave it and see what happens.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on April 04, 2009, 07:58:44 PM
Hi Chereb,

I think I know exactly what you are talking about.  If you go back to the first or second week of postings you will see that I complained of a eerily similar type of pain along my medial joint line (def. bone and not muscle or tissue, similar to arthritis but more intense, almost like an electric shock).  I was extremely worried, like you, that the new angle was not right or that I wasn't healing, etc. The pain was pretty debilitating in that I would try to put weight on the leg and then it would give out and I would feel weak, I think from the pain. Granted I experienced this a little earlier in my recovery but I think that was because I began partial weight bearing earlier than you did (correct me if I am wrong).  At that point, I stopped bearing weight all together.  I continued with ROM and non-weight bearing strength exercises, but crutched along without even putting a toe down. I cannot remember how long I did this but I think it was only a few days, a week at the very most, and the pain went away and never came back.  It could just be that your body has felt the weight, recognized it is a new angle and needs to adjust. Unfortunately, by continuing to bear weight and try and try again, the body is getting the time it needs to adjust. I am purely speculating here but my advice is to take a couple/few days off all together and then revisit it very very gingerly and progress slowly over the course of a few days as to the percentage of total weight you are bearing. Deep breaths, don't get discouraged, it is a process, and certainly don't second guess your decision especially this early in your recovery.  I don't believe one should evaluate the effectiveness of the surgery until at least 6 months post-op.  Hang in there, you are doing great.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on April 04, 2009, 08:06:09 PM
Oh, and to your question about weight, I didn't lose too much.  I made a conscious effort to not weigh myself until I felt I had gained back a good amount of muscle mass in my leg.  I didn't want to 1) get depressed about how much muscle I lost, or 2) think that I was getting slim and give myself cart blanche to eat more liberally than I might otherwise.  If I am speculating I would think a lot of the weight loss is quad atrophy, you are burning more calories to just get around and you may be having a hard time accessing food since you are less mobile.

To the questions about wearing a brace.  I got to lose mine all together after 4 weeks.  During PT I wasn't wearing the brace after the first 2 weeks. Depending on the brace you have, the entire purpose could be to limit ROM. My brace locked out at 0 degrees extension and 110 degrees flexion.  However, until I met those limits, the brace was helpful in measuring my progress to the degree.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 04, 2009, 09:55:55 PM
Hi Aturpin, Yes i read your posts and as you say they were very early on in your recovery. I  guess we all recover differently. I have a completely unlocked brace, no hold ups with that for me. I am putting in 2 and a bit hours of physio evey day. It has almost become so much of a routine that i get tetchy and upset if i have too much pain to go through it and continue to push. Its mad i know but i so want to get back to at least walking. I feel that i am putting in so much effort and getting little reward if that makes sense. At the minute i have decided its a day by day thing. Some days are more/less painful than others. I can walk around the house although my gait is severe. It is improving though.  I am doing the rom exercises, side steps, hip exercises and basically working all the knee/leg muscles associated. The medial pain is still there although a bit l ess. I am very aware of it now and being careful not to push too much but enough that I can get some results. I can go upstairs using the handrail a step apart now so thats an improvement. Going down is still one stair at a time although im working on it. Th rom is coming slowly. I feel above my knee is so tight and its a real pull to try and get it looser. ll the hard tissue has almost gone with the exception of above the knee and around to the wound. I have developed a bit more positivity today. I got up and the leg felt stronger again. It seems tat every 2 days i notice a stronge improvement. I am hoping that the medial pain will just go away and when i see my os on Monday i will talk to him about it.  I just need reassured that nothing iswrong and its normal,lol. I have been trying cycling moves with my legs but the unoperated knee is having real problems with it. The operated leg is ok with it so i am going to try and continue and hope that it loosens up the tightness. This will sound odd but I love hearing all the cracks, ect in the leg as it brings another bit of motion with it!
I am so glad I found you guys on here. Its very hard for anyone to understand. Its good to see everyones experiences and know that you are not alone with it. You have been great Aturpin and i sincerely thank you for that.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 06, 2009, 10:50:24 PM
Me again!! Just  an update. Been for my follow up today. I am officially without the brace. Os seemed really pleased at my progress. Apparantly im quite ahead of the game. I dont know how he came up with that! He is happy with the rom, muscles around the knee ect and said i could probably be discharged from physio now and continue as i am. I am assured that once the bone eases in to position the pain will go. So i am feeling much better. The break is healing well and everything has stayed in position. I had the maximum opening possible for the wedge so lots and lots of gap to fill. I dont have to go back for a few months so all is looking well. I am still in a little pain but it does seem to be easing a little each day. My rom is increasing daily and the knee is feeling looser each day. Hopefully it will continue nicely and before long i can walk with a nice gait (also improving) Hope everyone is well!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on April 07, 2009, 01:55:44 AM
Congrats on the good news chereb! It's always a bit relieving to hear that you're on the right track and even more ahead of the game than planned. I think sometimes we're all extremely hard on ourselves and think that we're not really getting anywhere with our rehab when in fact we're making really great strides. I hope that everything will continue to move forward and your pain will subside soon!

I'm now 6 weeks out from my ACI/osteotomy. Working on getting my strength up and doing everything possible to physicall prepare myself for the very demanding road ahead of me. Because I'm having ACI too I'll be on crutches for 4-5 months...toe tough weight bearing for the first 6 weeks then gradually adding more weight about every 2 weeks. I'll need all the strength I can get!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on April 08, 2009, 06:16:34 PM
Chereb, if you're like me it just seems like you should be so much farther than you are even though you're doing fine.  I think I'm to hard on myself sometimes.

I had a pretty big opps moment last Friday. I tripped and caught myself on my right (surgery) leg then sorta jumped up on it to keep my balance. :-/ I was excited that my muscles held me up though. Its still really sore though. I'm sure it didn't mess anything up, just that the muscles didn't like being tight around the plate.  6 more days til I can start  ditching the sticks. yay!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 08, 2009, 09:30:30 PM
Hi Guys, Yes i do think we are hard on ourselves.  I notice the majority of us here are women ;) I feel like i need to be back to normal for the family ect. I snuggled my four year old on my knees for the frst time today. She is quite heavy and it was quite painful if i tried before and she would wriggle around hurting my thigh. I cant tell you how good it felt. It hurt a little but not enough that i had to get her off,lol. I cant beleive how i am progressing this week. Its like a steam train woke up in my leg. I cleaned the house today, top to bottom with no crutch. There is still a swelling issue and some pan but i do feel like losing the last crutch is iminent. My distance without the rutch is getting better by the day. I am still wary coming downstairs though and hope i keep getting more confident. I drove on Friday  for the first time and it was so go to get out in the car alone! :D I awoke this morning and was half way down the first set of stairs when i noticed i had left the crutch behind. Never even lifted from the bedside. I felt quite exitable. Stupid i know but it was like a little sign telling me how good its going. Our household is mostly back to normal. My DH is vey glad i think as for weeks he has been doing most of the school runs, cooking,cleaning,laundry  and working long hours on top. I have gradually slipped back to the normal routines and was remembering how at he start i could not even put my own underwear on without help,lol. I suppose im a long way from where that was!

I would also like to ask opinions on somthing. I need another osteotomy on my left leg. Originally the plan was to leave a few years between surgeries. However I am now thinking maybe i should do it a year from now. My family think im crazy but im a bigger picture person. If i wait longer then i am going to be facing surgery every five years. If i did it next year it would give me 8 until the first TKR so going by te predictors for the ops i would gain longr between each lot of surgeries. What would you do?

 Nikkiluv you are doing great and i hope you keep getting stronger.

Jumpi5d I remember counting down the crutches and will be glad when i can ditch my outside use one! I only use it outside because my leg gets fatigued quite easily just now.

Good to hear everyone continues to do well! :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on April 09, 2009, 01:44:45 AM
Thanks for the encouragement, Chereb. Glad to hear that you're coming along so well from where you seemed to be even just a week or so ago! AWESOME that you were able to clean the entire house and get around...and start driving by yourself again! I think about how it'll be to have such a freedom taken away for so long...I'm having ACI with my osteotomy so I'll be on crutches for 4-5 months. When I think about not being able to drive and go places whenever I please it's a bit sad, especially since I absolutely LOVE my car, haha. But, it's a small price to pay to hopefully end up pain free and be able to drive my car for many many years down the road. Hopefully you'll be able to ditch the last crutch very very soon!!

Yes, I feel that my strength is doing well. I didn't really lose any after my ACI biopsy so I was super happy about that. I had been working out biking and doing other strengthening things since my last surgery (a lateral partial menisectomy) when I was able to start doing rehab, which was about Thanksgiving time. I try to bike atleast 5 days a week (I usually take the weekends off because I work early in the morning so it's hard for me to wanna get up at like 6am to work out lol), so I feel like I'm doing really well. Things are getting easier and I can handle more challenging resistances and still feel good at the end of the workout.

Not sure if I mentioned it on here or not already but I just bought myself a recumbent bike almost 2 weeks ago and it's the best bike ever!! I decided to make an investment in my rehab and future health and buy a really nice bike, especially since it's one of the only things I can do right now and it'll be one of the soonest "substantial" activities I can do following my surgery. I decided on the recumbent because it felt better on my knees, and also because it will be a lot easier to get on and off while being on crutches. I tried mounting an upright one at the store and my mom took one look at me and almost had a panic attack imaging me, right after having my leg sawed and plated/screwed back together along with having slushy cells for cartilage, trying to get on the upright bike using crutches and not putting any weight on my right leg. She said I'd need a spotter on each side to get on, off, and ride the thing. With the recumbent I can crutch over to it, sit down, and swing around and start pedaling. The seat and pedaling part are separate so there's not even a thing to climb over so it's definitely surgery friendly. Overall I'm very satisfied with it and look forward to "pre-habbing" with it. :)

Hope everyone else had a good day today! :)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on April 09, 2009, 03:05:29 AM
Nicole, its hard to think about putting yourself through it. I still think about it sometimes, but you just have to remember that its 4-5 months of doing nothing or hurting for the rest of your life? You figure out ways to do a lot of things after a while.  The bike you have sounds like the one I've been on, haha my mom said the same thing about not getting on a regular one.

chereb, I'm not having mine done for arthritis but mostly to prevent it and get my knees tracking straight. I'm planning on having the other leg done in September. It'll be just over 6 months apart. I'm like you the sooner I get it all done the sooner I'm back to normal. I kinda want to wait just to have the time between them but the sooner they are the sooner I feel better.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: lady on April 10, 2009, 05:46:14 PM
Thank you all for your posts. Especialy you Atuprin. I was told today that this was a possibility for me. As soon as the doc said it I came home to research I did have some idea of the surgery from reading this site. I have read all of your posts in the last hour and at times I felt very overwhellmed (I've had surgery before so I know what rehab is like) but I prefer to learn all about my knee and procedures that I have or may have. Thanks to all of you.

I have had 3 series of hylan injections today being my last injections in my 3rd series. The 1st series worked the 2nd did not (infact I had some side affects and had to have it drained and a cortizone injections). If this one does not "work" then I may be heading in the same direction as all of you. I have been wearing an unloader brace for about a month and doing Pt for about 2 months. PT has helped a bit but my quad is still not what it should be and my leg over all has gotten much smaller. (never thought that would bother me before, skinny leg oh no, lol,). So I asked the doc what if the shots don't work...and I then said the only thing that as really helped me walk better and have less pain is the brace. Pain was at times an 8 now I can say I flex between a 2 or 4 depending on activitiy level (I'm hyper!) he was thrilled and said then that tells us you have another option. GREAT! better than a PK or TK BUT he kinda freaked me out when he said "we can break the knee realign it"  blalblab, it did get much better when  I said excuse me!?! break it to fix it. Pretty funny...hahaha.

So I jumped on hear read all your posts and I'm worried and excited if I need this and I actuly think I want it. I want to be back doing the things I love. Somethings I know I can do anymore but somethings I just have to/want to so badly. I loved to box (for fun) but that is probaby out and I can give it up, hike is my #1, biking too, coaching/playing soccer is not an option! I have to coach.

thanks again and good luck all with rehab and best wishes for contiuing success at an active lifestyle.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on April 14, 2009, 01:46:08 AM
Post-Op Day 128 (April 13, 2009) - Hi everyone.  I have been away from this post for about two weeks and I missed so much.  Everyone is practically good as new.... well, getting there.  But seriously, people are forgetting they need crutches, catching falls and hopping, it is really great to hear.  Congratulations to chereb and jumpi5d!  I think our collective experience through this whole procedure provides a pretty solid example of what to expect from the procedure and that makes my happy.

As for me, I am doing great...I am just over 4 months post-op. Part of the reason I have been MIA is that I went on vacation to Washington DC for an extended weekend.  I wasn't sure how my leg would hold up so this was a really interesting experiment.  All in all, I have never done more walking in my life, not even in NYC. I figure I probably walked about 6 miles each day (rough estimate) though at times it felt like 100 miles. The first day my knee got a little upset and swelled up.  I iced twice the first day, once the second day and not at all for 3 and 4.  After the first day, the swelling went down and the pain and achiness subsided.  I am really pleased with how it performed and feel closer to being back to normal. By the end of the trip my feet were hurting way more than my knee.

At this point in my recovery I am pretty much there.... done with organized rehab and done making big milestones or having big setbacks. I will continue to work at strength gains, reinforce ROM especially if it gets stiff, workout, hike, introduce new activities etc. but the rest is just up to time.  Each week that goes by I feel a little better and a little more capable and it is just a function of time. In the begining I was able to make huge gains with hard work, and have huge setbacks and now I am much more even keeled.  I am capable of doing most things I want and am slowly feeling "normal" again. If I had to guess I would say it will take another month maybe two months before I feel 90-100% but right now I am at about 75% (better on some days and worse on others) and appreciate how far I have come. I can see the light at the end of the tunnel!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 18, 2009, 05:16:51 PM
Hi all. How we all doing. I had my physio session this week and was shocked to find that i only gained 5 degrees rom!! It was a little disheartening after all the work i have been putting in. Physio tried stretching it but still couldnt gain an extra degree. My knee and the thigh above is absolutely packed with scar tissue and the thigh is so thick it just will not budge!! My goal for next time is to try and stretch and break the scar tissue! Popped some behind the knee already. Not a pleasant sensation but needs must!! My gait still needs a lot of work but is gradually improving. Got my crutch replaced with a stick!

Aturpin..glad you had a nice trip   
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on April 22, 2009, 09:22:49 PM
Post-Op Day 137, 4.5 months (April 22nd, 2009) - I have been spending some time thinking about the next operation in store for me (OATS or allograft) for the cartilage defect on my lateral condyle.  I might be putting the cart before the horse as I still have progress to make on my osteotomy recovery but I can't really help it... particularly since a lot of the pain and discomfort I am getting these is less from the osteotomy and more from arthritis. So, I was searching through the wealth of information on this wonderful site and I came across a board called "Success Stories." It was uplifting to read instances of people going through so much and coming out better for it.  Even more beneficial was post that put "success" into perspective.

A lot of the time when we talk about our progress, our comments and thoughts are couched in different perspectives or expectations.  For instance, a success to one person may be simply feeling better than they did before surgery whereas success to another person may be returning to 100% of their peak performance level.  These expectations may result in different perceived levels of an operation's success so when we say "I am doing great" or "I am recovered", that means different things to different people. Long story shorter, I came across the following metrics for progress that I know we can all relate to that will put into better perspective my progress through 4.5 months post-op distal femoral osteotomy.  I hope this gives those of you who are reading my blog to get information on what to expect, a more accurate or precise idea of where I am at. I only wish I had stumbled upon this earlier in my recovery but I will do my best to recall the earliest point at which I could accomplish each task.

Ten-plus tests for successful knee surgery:

Is the patient able to:

   0. WALK on LEVEL ground without aids (cane, crutches, etc.)--- for at least 10 to 20 minutes --- with essentially no pain or irritation?
-- Yes, I can do this. I can say with a fair amount of confidence that I could do this at 3 months-ish

   1. LOCK the knee joints straight and STAND FOR MANY MINUTES, on BOTH legs, with no problem (because your bones are carrying your weight, not the quad muscles)?
-- Yes, I can do this.  I am not sure what constitutes many minutes but I can stand for about 15 before I begin shifting my weight back and forth... however, I might shift my weight after 15 minutes pre-op too. Suffice to say that standing for several minutes is doable and has been since about 3 months-ish as well.

   2. BEND the 'subject' knee enough to pull on SOCKS and SHOES?

--Yep, this is an easy one. This is entirely dependent on how quickly one regains their range of motion.  I was able to comfortably (meaing I wasn't contorting myself or reaching really hard) and easily execute this move at 2-3 weeks if I recall correctly.

   3. Get IN AND OUT of a CAR without having to grab THE LEG to help it BEND enough to CLEAR the DOOR?

---Also dependent on range of motion (and perhaps the type of car), I could do this at about 2 weeks
   4. STAND UP from a LOW CHAIR or the toilet without pains --- and without having to use arms to reduce the load --- and without
      having to go through 'a ritual tweaking of muscles' or compensating heavily with the good leg?

---Yes, I can do this very comfortably now.  I am on the brink of being able to comfortably get up from a low crouch (problems doing this, for me, have to do with the missing cartilage and not the osteotomy though). I think I could probably get up from a chair without thinking about it at about 3 months. It seems like a fairly easy maneuver that shouldn't take that long but you have to wait until you are allowed to be full weight bearing and also be capable of doing a squat, in essence.

   5. Sit still for a hour or so and be able to get up without the sense your knee has rusted fixed? I.e. get up from an HOURS-LONG SITTING-SESSION without significant pain and without having to go through 'a ritual tweaking of muscles'?

---This is still a work in progress. When I get up from a chair at work I can definitely feel stiffness but I don't have to limp or tweak anything, a few steps (maybe a dozen) and it loosens up

   6. STAND on THE ONE LEG (no weight on the other) for about a minute without pain?

---Yes, I can do this.  This is somewhat dependent on whether or not one can balance on the leg for a minute.  But, this is something I have been working on and have incorporated into my therapy. I think I could probably do this at around the 3 month mark.

   7a. LIFT THE 'subject' LEG up and BEND it and PROP it across the other knee in the SHOWER, to REACH your TOES (to clean between

--Yes, I can do this.  It is hard to say when I could start doing it but I am sure it was a lot sooner than 7b... before I started walking so maybe 8 weeks?

   7b. LIFT THE 'other' LEG up and BEND it and PROP it across the 'subject' knee in the SHOWER, to REACH your TOES (to clean
       between them)?  (i.e. put all your weight on the subject knee)

---This has to do with balance and also with putting pressure on the surgery site area.  I can do this now easily and I think I could start doing this at around 12 weeks/3 months.

   8a. Go  UP  STAIRS with no pain or stiffness?

---I am an up stairs champ now... I can skip steps, I can almost job them. No pain. This is a fairly recent accomplishment say maybe 3.5 months/14 weeks where I started to really feel comfortable going up.

   8b. Go DOWN STAIRS with no pain or stiffness? (Going down is generally harder than going up.)

--this, is a different story. I am close to being as comfortable going down as I am going up.  But, I still think about it everytime I am at the top of a flight of stairs. I find that the more I force myself to stop compensating and do it right, the better I am.  The first few steps feel sore but by the 4th step I don't have as much of a problem. Again, I think this may have something to do with my arthritis as well.

   9. Stand on one leg and lift the other leg (with the 'subject' knee) by the ankle and PRESS THE ANKLE AGAINST one's RUMP?

---This is a new accomplishment for me. I have full range of motion now but if I keep my leg in one position for a while or dont stretch the knee, it takes me a minute or so of squatting down on it before I can get my heel to my butt. After that, no problem and I have been able to do that for a while now (maybe since 10 weeks, not sure but I know I detailed it in my blog).  Now, doing a quad stretch and getting my
heel to my butt took longer because my quad has been tight due to all the trama and to them cutting through my IT band to get to my femur. Nevertheless, I can do this and probably acheived this within the last 2 weeks.

  10. KNEEL down with the knee on a hard surface?

--No problem.  I have never had any problems with kneeling or sensation in any of my surgeries though including the ACL. I would say I could do this at maybe 2 months, maybe sooner.

  11. Do a full, complete SQUAT?

--- Yep, no problem. could probably do one without compensating at about 3.5 months.

  12. Sit (and un-sit) comfortably with your legs CROSSED?

---Yes, I can do this but probably can't sit cross legged for more than 10-15 minutes before the knee gets achy. This is dependent on both ROM and time... I could probably do this at 3 months.

  13. Do almost any 'normal' knee activity without bouts of SWELLING?

--I dont swell that much anymore. I recently went to Washington DC and did a ton of walking and it swelled up on the first day.  Not much beside that.  I'll say this might still be a work in progress but swelling isnt too much of an issue at this point.

  14. Do almost any 'normal' knee activity without bouts of PAIN?

--I don't know what this means.  What is normal. Also, I dont know if it is fair to comment on this since I am still limited by arthritis.  I can do most things now...i.e. cycle, swim, walk, elliptical, stair master and it doesnt hurt when I am doing it.  sometimes, the arthritis gets upset after lots of stairs. I am also golfing and not having much trouble.

  15. Move the knee through the RANGE-OF-MOTIONS that one was 'born with'?

---Pretty close.  After about 2-3 minutes of manipulation I am damn close.  I feel a little more resistance on the subject leg when my heel gets closer to my butt... but, I do get the same ROM. I have probably been able to do this since 3.5 months

  16. Do one's favorite ATHLETIC ACTIVITY --- or favorite 3 athletic activities --- with hardly any consciousness of the knee? (swimming, jogging, baseball, tennis, basketball, ballroom-dancing, football/soccer, break-dancing, hacky-sack, gymnastics, etc.)

---really shouldnt comment since I am still a surgery short of these activities. Swimming is about the only thing on that list that I do without consciously thinking about my knee. If I were to speculate, I don't think even without the arthritis that I would be comfortable doing any other activities without thinking about the knee at this point. Maybe after another month or two.

  [Many surgeon studies/reports just use 'range of motion' to test success of surgery --- as judged by the doctor, with no feedback from the patients.  The tests above provide a set of patient-oriented, 'functional' criteria for success.]

I am sorry this post is so long but I hope someone out there found it helpful. At the minimum, it was helpful for me personally when evaluating my progress relative to functional activities and to see where I need to improve still.  I also noticed when answering the questions that I made a lot of my most significant functional gains at around the 3 month mark or at least somewhere during the third month. This could be good information to have when deciding when and if to have this surgery and planning for it.  Can you or when can you afford to be less functional for 3 months?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on April 23, 2009, 04:45:17 AM
Aturpin that was awesome to read. I'm so glad to hear that everything is still going good. I can't believe that my surgery was 7 weeks ago! I'd say off that list I can do about 8 of them. I've never been able to cross my legs so can't count that one. I can't stand on the surgery leg by its self yet. I can take about 20 steps without the crutches though! yay! Everyday seems to get a lot easier. I still have rough nights sometimes though, but I guess thats to be expected. I go back to the doctor the 5th and I'm hoping he'll tell me not to come back for a while. Haha.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lea50 on April 29, 2009, 01:16:50 AM
What a great post.  Aturpid, I've really enjoyed reading your diary.

All the best with your continued progress!!!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on April 29, 2009, 02:38:46 PM
Hi all, Went for my PT evaluation yesterday. Rom measured in at 110 degrees (yay!) After a workout on the bike and then the PT trying to bend it we got to 120 degrees. Still having pain but it is getting less. My PT has also told me I have a huge bakers cyst now and i may have to get it drained off. I am starting to use a bike daily now and hope to get my rom and gait much improved over the next few weeks. I go on holiday in 6 weeks and it would be awesome if i could walk normal,lol I have slowed down on some of the PT as it did seem to aggrivate the pain. For a little experiment i tried something different ! My last PT post i had only gained 5 degrees despite doing 2 and a half hours of physio daily. So since 2 days after that up until yesterday i did zilch! Well i kept up with the rom but ditched the rest. So gaining 20 degrees was a little puzzling,lol. I told my PT this and i know previous athroscopes gave me the same prblem. Physio made it swell, pain and not do well. Little physio and recovery from them was quicker. So i wonder if i am maybe someone that the PT just does nothing for. I feel i have progressed way more since stopping. So i am going to keep this up. Just going to use the bike and continue rom and thats it!!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 05, 2009, 05:44:05 PM
Post-Op Day 136 (May 5, 2009) - Tomorrow will be my 5 month post-op anniversary and all is well.  I am now biking to work 3 days a week (not far, 5 miles) and continue to be pretty active. I am going to spinning class at least once a week and have really noticed improvement over the past month.... especially when compared to 3 months ago.  I am compensating very little for my subject leg and am able to cycle evenly between the two legs even when out of the saddle. I have also noticed within the last two weeks that I am right on the cusp of going downstairs without thinking about my knee.  Sometimes I concentrate on going down without cheating and other times  I do it without even thinking about it.  Going downstairs is not painful or anything anymore (except if I am having a particularly sore day due to overworking it the day before).  Last weekend I put together a dresser and found myself squating and lunging, sitting on my heels, kneeling, and sitting Indian style without problem; it was actually really good for my flexion. I need to work on my hamstring strength and continue to build quad and glute strength but I feel, for the most part, back to normal (whatever normal is). If I had to assign a percentage I would say I am 80-90% of my pre-op form.  I think the true test will be a good solid hike, that seems to be the toughest on my leg.  I expect to do this in a couple of weeks and will report back.

I see my doctor next week and am looking forward to speaking with him and seeing my xrays. I will post what he says regarding my progress, healing, etc and future surgery and then will keep my posts to a monthly update or so after that (unless, of course, something big happens).  But, feel free to continue posting your progress and experiences on this thread.  I think the more information the better and welcome everyones experiences with this journey.

Thank you to all of your encouragement and for those of you who have given compliments on this post, I am really glad to see people are benefitting from it. I hope the information here gives you peace of mind as to what this procedure is really like as well as all of the information you need to make an informed decision about whether this is the procedure is for you.  Please ask any questions you might have, there is a wealth of experience and support to draw on here.

I was reading a lot of the clinical longitudinal research for my upcoming OATS procedure and those patients who went into their OATS procedure with malalignment like I had all experienced either failure or a diminshed result.  It was very validating to read this research and even though it has been a challenging few months, I am happy with my decision to have the osteotomy and if I had it to do all over again, knowing what I know now, I would do it again.

Congrats to Paige, it sounds like you are coming along so well.  You are coming up on 3 months post-op now, it  all gets easier from here, you made it through the hardest part.

Congrats also to chereb, keep up the good work and progress.  I think PT is only good when you do enough to see progress and cut yourself off before you go too far and get swelling, stiffness and achiness.  For some people it doesnt take much to get there. You know your body and your limits so don't let people pressure you to do more than you know you should.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on May 05, 2009, 06:20:35 PM
Hi guys,

Not so good news from me. Went to see Doctor regarding the bakers cyst. She has early reffered me back to OS. Cyst needs drained and no way to make full rom without that being done. There may also be an underlying problem which we have an idea of but hoping to be wrong. It does relate to the ongoing medial pain which is back with a vengance. The swelling is also back full force and i need to stop burying my head in the sand with it. There is something not quite right and the doc agrees that there should not be the same level of pain and swelling. I have PT on Friday again an will await an appointment with the OS which should be fairly soon. Keep your fingers crossed for me that i dont get bad news.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 05, 2009, 10:16:01 PM
Hi chereb,

I am sorry to hear of your setback, it must be frustrating to have to go through another hurdle. On the plus side, now you know why you were having such a hard time getting ROM and why you were having joint pain...that is a good start for forward progress. Keep your head up and stay positive.  My fingers are crossed for you!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on May 06, 2009, 06:05:40 AM
Hi everyone,

Well I'm only 12 days out from my surgery: May 18th. I can't believe how much has happened and how far I've come since February 5th, from having my initial consult with my new OS, to x-rays, an MRI, my ACI biopsy, insurance approval, and now finally the big day is coming close. Things have happened quickly which is good because it's given me less time to really think and ponder about things (the 7 week wait between scheduling the surgery and waiting for it has been pretty agonizing counting down the days), but also because I really just want to get it done and over with and on the recovery road. I had my pre-op physical last week and lab tests done. My PCP cleared me for surgery and I'm just waiting for the labs (which I expect to be fine). I also faxed the paperwork applying for a temporary handicap placard to my OS so hopefully they can fax them back to the DMV soon and I'll have the placards before my surgery. I'm trying to do everything I can to help speed things along and make sure everyone gets everything they need prior to surgery. I've also been trying to work out every day doing mini squats, sit ups, biking, stretching, along with arm free weights, etc. to try and gain as much strength as possible prior to surgery. I definitely feel a lot better since pumping up my routines a bit and working harder. Hoping it truly pays off after surgery when I'm on crutches and stuff for so long!

Aturpin, glad to hear you're doing so well! Reading your posts is helping me to keep a positive outlook on my surgery (I'm having a DFO with ACI). Thanks so much for keeping such a detailed diary and keeping us updated!

Chereb, sorry to hear about the cyst. I hope nothing else is really the matter and then once they drain the cyst you'll be hopefully on your way to a full recovery.

I plan on definitely keeping a diary myself after my surgery. I'll be in the hospital for 3 days following my surgery so hopefully within a few days afterwards I'll be able to update and start it.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 18, 2009, 02:14:04 AM
Post-Op Day 148; 5 months and 11 days; (May 17, 2009)- Hi folks!  I met with my OS last Thursday the 14th so I thought I would share the outcome of our meeting as well as the before and after xrays he gave me.  It is amazing to see the difference in the angle between the two xrays.  There may be some uncertainty among osteotomy candidates as to the whether or not this surgery is worth it but after seeing my xrays, there is no question that this surgery improved my joint angle 100%.  Dr. Bugbee showed me my full length xrays (not posted here) and drew a line from my hip to my ankle and the line passed directly through the middle of my knee at the notch between the two condyles. Before the surgery, that line passed through the middle of my lateral condyle.

As for my progress, he was very positive.  He said that I was coming along better than 99% of most patients.  I don't report this to be bragadocious and I hope it isnt perceived that way, I just want to put my progress in the context of the greater population.  If you are considering this procedure and are reading my posts to see what your experience will be like, you should consider that my result has been either better and/or faster than many.

We also discussed my plans for the allograft procedure I have in my future.  He assured me that we are no longer in emergency mode now that my alignment has been corrected and the weight load has been taken off of the defect area. He suggested I wait another few months before deciding when to have surgery and suspects I may have a significant relief of my symptoms now that my alignment is corrected.  Here's hoping it disappears all together :).

As for my symptoms and activities of daily living, I am continuing to make progress and incorporate new activities into my repertoire.  Last week I did power cleans (with little weight), golfed 12 holes (no cart, walked), and didn't lateral jumping lunges without pain or swelling.  I am noticing that my leg isnt begging for ice after activity like it used to which is nice.  I went on a 90 minute bike ride today with some fatigue in the subject leg but no pain. I am also favoring the subject leg less and less but am not quite 100% even yet. Lastly, I have mastered going downstairs without concentrating or favoring.  I took a few jogging steps the other day with the most comfort yet but I was still favoring slightly.  I shouldn't be jogging anyway so I wont be spending much time on improving this. On the downside, I have some scar tissue on my IT band and quad that I am continuing to work through. I am noticeable tighter on my subject leg.  Also, I noticed that after I do a lot of exercise, I am having stiffness over my plate.  I was attributing this to my arthritis but it occured to me that the pain is too superficial to be arthritis and it is right over my plate... can't wait to get it outta there.

I feel very fortunate to have come this far and hope for continued progress.  If I had to attribute my results to any factors I would consider the following to be most beneficial to my outcome, my recipe if you will:  1) my age; I am only 27 so I have that advantage; 2) my fitness level;  my BMI is 21 and I went into the procdure with good strength and in pretty solid shape; 3) work ethic; I continued to workout as much as I could after surgery without risking my surgery leg.  I think this helped so much.  I was also diligent about PT and getting ROM; 4) Lastly, I was compliant...I followed DRs orders. 

So this is where Im at so far. I wish the best of luck to those of you who are recovering or deciding on this procedure.  As I get further along on the recovery road I can more confidently say that the pain and time was worth the outcome for this procedure.  If I had it to do over again knowing what I know now I would go through it again (thats not to say I would be skipping into the operating room with a smile, its a challenging and long recovery, just that its worth it). 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on May 18, 2009, 02:52:46 AM
Hi aturpin,

Glad to hear that you're doing so awesome after your surgery. My big day has finally come, it's tomorrow (Monday). I'm having a DFO along with ACI of the lateral tibial plateau. I'll be in the hospital for three days (until Thursday), and hopefully when I'm up to it I definitely plan on starting a diary and writing about my experiences. Your diary has helped me so much and I'd love to offer any advice to others that may be in the same position as I am. I know it'll be a long road ahead, but I'm trying to look forward to it in anticipating of having my entire life back being pain-free and not feeling like I'm 80, instead of dreading the next year or so that I'll be spending rehabing. Slow and steady wins the race right?

Thanks again for all your help. I hope everyone else on this board is rehabing along nicely still.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on May 18, 2009, 03:21:04 AM
Heyy! I since everyone else is updating think I should too? I'm free of crutches! It only took 10 weeks. I've been walking little distances since about 7 weeks. I have 125 degrees ROM. Doctor told me about a week ago that he wasn't going to put me in therapy to just keep doing what I'm doing.

Aturpin, isn't it awesome getting to see the difference. My doctor's shown me that at both of my follow ups so far. Its crazy! I'm glad that everything is still going well for you.

Nikki, Good luck tomorrow. I'll be thinking about you through the day. I'll be looking forward to your diary. I wish I would have kept my online journal up. I kept it up on paper though. Don't think about the next year being horrible it's all leading up to the point of being pain free and having a life again. It's a long boring rehab but for me  I can already tell so much difference. I've been begging for them to do my other leg. 

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 18, 2009, 04:57:29 AM
Before and after...
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 18, 2009, 05:05:36 AM
Paige - Congrats on getting off the sticks!  It is such a great feeling to be mobile again.

Nikki - Good luck tomorrow, you will be great.  Be excited that you are that much closer to getting back to good. Keep being positive and focus your efforts on healing, you'll be there before you know it.  I will also be curious to read your diary...very few people have done an osteotomy and ACI so your experience will be very valuable to others. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on May 18, 2009, 07:49:25 AM
It is great to be mobile. I was begining to think it was never going to happen. I still couldn't go shopping without them but I'm good for the most part. I'm good about 30-45 minutes but then I can't make it any longer. I love the xrays. I'm kinda jealous that you don't have as much metal as me. I swear I have tons!  This is not the best one but heres a picture of my 9 week xray. It's healing really well just has a LOT to go. I figured it'd be a lot more filled in by now.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: lady on May 18, 2009, 10:47:20 AM
Amazing pics. This diary is amazing. Good Luck nikkiluv.  ;)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 18, 2009, 04:50:11 PM
Wow Paige, you do have a lot of metal.  My xray is a little decieving when you look at it from the front.  If you look at it from the side you can see the "spacer"/jack that kept the gap open and the top and bottom of the plate.  I will post that later if I can. Also, don't worry about not having the bone filled in completely yet.  My PT people told me repeatedly that bone needs to be stressed to continue to build up.  So, as you continue to walk more and do more exercise, the bone will fill in faster.  Keep up the good work.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on May 18, 2009, 06:41:28 PM
Paige, well done on ditching the sticks.
Nikki hope everything goes great.
Aturpin, wow you are doing so good. Well done for coming so far.

I went back to see OS today. Xrays showed that i am still in the early healing phase. The cyst is just going to have o go by itself,lol as there is to much fluid in the knee to warrant draining. Also the xrays showed that the joint has dropped. I have no idea what that means as he just kept saying i would finish with a better outcome. It does explain the change in shape of my leg though as we had all noticed it looked rather odd. Also my plate and screws have to come out. So when the bone is perfectly healed the scar will be reopened and hardware removed. It prortrudes out and is painful if touched. The area bruises with the slightest prod so it has to go. Overall im doing a bit better. The joint is still quite painful but im getting there. Still limping but needing to use the one crutch less and less. I go on holiday in 3 week and its more than likely that the crutch will come with me. I am just going to keep working and hopefully it will be alright in the end.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on May 18, 2009, 06:51:20 PM
Chereb, Thanks..I'm still using one once in a while or two for long distances. I still have a pretty good limp, but if I really focus on how I'm walking I can go some distance and not limp but not a long distance. My metal has to come out at around 1 year post op. The doctor said that mine sticks up around 1/2 inch off the bone and then the screws maybe a tiny bit higher than that. It's really tender when I touch in that area. Its been 10 weeks and I still have some bruising around it.

Aturprin, I was just giving you a hard time ;) any metal is to much!!! My doctor told me the same thing. He also said it could take anywhere from 2 weeks to 6 months to completely fill in. He said that he left a pretty big gap but he was very happy with where it was. Heres another xray (aturpin hope you don't mind me sharing here.) for all you guys to see. This is at 9 weeks too.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 18, 2009, 11:15:03 PM
Side view pic...
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on May 24, 2009, 02:57:32 AM
Hi everyone,

Well I'm now 5 days post-op and doing fairly decent. I'm able to get around pretty good and the pain right now isn't too too bad for what I've been through (it's always a day to day thing). I came home from the hospital Thursday. I'm on a lot of meds and my pain meds dose is pretty high so with everything I've been really tired and sleeping a ton so haven't been up much or felt like posting.

Anyways, I've decided to let everyone know that I'm going to make a post-op diary and was going to post it under the post-op diaries section and label it Nikki's Post-Op Diary for Distal Femoral Osteotomy and ACI - May 18th, 2009. I was going to put it there because I post on the patellofemoral board, the ACI board, changing forces through the joint board, and thought that if I just let everyone know on each board my diary was there hopefully everyone would go there and follow it.

Thanks everyone for your well-wishes, I appreciate it greatly. :) Hope everyone else is doing well still!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: lady on May 24, 2009, 06:05:26 PM
Glad to hear how your doing. I love all these diarys. They are so helpful. Good luck and take it easy. ;)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on May 29, 2009, 06:56:10 PM
First, I want to say that everyone seems to be making great strides, no pun intended :-)  I realize now that progress is progress and we are all different and will improve at different rates and that each little bit of improvement is a step toward being in a better place than before our surgeries.  Chereb, Iím sorry to read that you are having problems but hope for you that it all works out. 

I pretty much dropped out of the post after about week two post-op of my DFO but wanted to step back in and fill you all in on my progress.  Aturpin, I hope you donít mind me adding all this to your page.

I had my DFO on March 23rd by the same Dr. as Aturpin, I think the main difference between she and I is that Iím 20 years older. 
ē   2 weeks I returned to work, a desk job, for Ĺ days (~4 hours).  I drive myself since surgery leg is my left leg.  That first week at work was tough staying comfortable.  I spent allot of time with my leg on my desk.  I also started going to outpatient PT that week and was put on a recumbent bike the first day for 10 minutes.  At first it really hurt to bend through the peddle stroke but after a few times around the pain subsided.  That week I continued taking a combination of Tylenol and ibuprofen, throughout the day. 
ē   3 weeks after surgery I was back to work full time.  I was riding the bike at PT for 15 minutes and started a leg press with just 15 lbs.  I was not taking the Tylenol or ibuprofen regularly during the day but noticed, especially after PT days that I definitely needed something at night to try and stay comfortable.  I was still waking a few times a night to get comfortable.
ē   Week 4 I saw my Dr. and was told my x-rays looked good and I could throw the brace away, which I did there in the office.  I was also told to continue using two crutches for 2 more weeks and at week 6 go to one crutch.  He says my ROM  was excellent and flexation, almost all the way, he was also impressed with.  My directions are to strengthen my quad muscle. Leaving his office without the brace on was kinda scary, I was worried I would bump or catch the leg and it would hurt.  One thing I did notice a few days after not wearing the brace is that the majority of the swelling that I still had, mainly behind my knee, subsided substantially.  PT started me on the elliptical for just 5 min. the day after I see the OS.  The second time at PT I go forward and backward for 5 min. each.  I do feel some pain, mainly in the medial side of the knee but not enough to stop me. 
ē   Week 5 Ė Iím just now taking a shower without the sitting on a stool.  I still just get in there and stand in one place and am barely putting weight on my leg, which I think I may be able too but am not supposed to be yet.  Iím supposed to be 30% of my weight.  Thinking ahead to what it would be like using just one crutch I try to focus on my gait and to put more weight on my surgery leg so that at week 6 I can function on one crutch.  PT says I can ride a recumbent bike for 30 min. the days Iím not seeing him.  When there I do 20 min. on a bike and 16 on the elliptical 8 ea forward and backward.  The elliptical is getting easier this week.
ē   Week 6 Ė Iím using one crutch and it is surprisingly easy.  By mid-week my PT says for short trips in the house, his office or work, I donít even need it.  I do find myself walking next to something to provide support just in case.  By the end of the week I go camping and directions from OS were to use both crutches on the uneven ground.  Which I do although short walks between tables and chairs I am ok without any.
ē   Week 7 Ė Most of the time Iím not using my crutch around the house and office.  Outside and longer trips at work I do still want the support.  My leg feels very week.  PT Iím up to 20 minutes on the recumbent and 20 on the elliptical and 75 lbs on the leg press and trying to focus that both legs are pressing to build back up that quad muscle.  No more over the counter pain meds probably stopped them a week ago.
ē   Week 8 Ė See the OS this week and show up crutchless.  I have not used my crutch for about 3 days when I see him and he is pleasantly surprised.  Says he only has one other patient (Aturpin I assume) that is doing this well.  He says I have slight swelling around the plate, which he told my husband after surgery, that the plate stays in unless it causes me problems.  My surgery leg still does not hyperextend as my good one does.  It does bend as much as the good one.  He releases me to activity other than jumping and running.  Says to increase at 15% a week and to see him in 8 wks.  I went swimming for the first time last night and I was surprised how poorly my leg felt and that that freestyle kicking did not feel as comfortable as a light breast stroke kick.  SO, I did what I could then went to the pull-bouy. 

WELL, I realize this is long and I do apologize.  Iíve meant to get on here many times in the past several weeks to see how everyone is doing and havenít.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on May 29, 2009, 07:02:51 PM
Here is a pic during my surgery of my plate.  I've been told it has a 7.5mm gap
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on May 31, 2009, 06:19:26 PM
Me again....has anyone tried swimming??  I've tried a couple times, starting at about 8 wks and am suprised how much pain I feel in the knee area doing the basic freestyle kick.  I can do the breast stroke kick, very gingerly, and that doesn't seem to bother the surgery leg.  I'm not sure if it is muscle fatigue or bone, I wouldn't think it is bone at this point but am not sure. 

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on May 31, 2009, 07:48:09 PM
I've been swimming if that's what you want to call it since 2 weeks out. I started trying to kick around 9-10 weeks and its still a big no no at 12 weeks. Dr. T told me that when it was comfortable for me to swim thats when I could again, but didn't give me a set time when I should be able too. Sorry I'm not much help :(
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on June 01, 2009, 07:18:29 PM

Nice to hear from you again and thank you for sharing your experience.  I am super interested in your progress since we had the same doctor so I am curious to see if there are any differences in our PT protocol, progress or, of course, I dont mind you posting here at all, the more information the better. I think its interesting that you were allowed to do the elliptical so soon.  I didn't start the elliptical until I was at least a month into full weight bearing. I am really glad to hear you are doing so well especially since, as your post mentioned, that you are 20 years older than me.  I think a lot of people assume that age slows the recovery timeline and they curb their expectations.  You are showing that that isn't neccessarily true. I am also glad you shared your experience about going back to work.  I was fortunate (or unfortunate) enough to get laid off shortly after surgery and had the benefit of taking more time at home before returning to normal life.  I couldn't provide the experience you did.  Also, I am due for another surgery in the near future and I will likely have to return to work after two weeks; now I know a little bit about the discomfort I can expect.

As for the swimming, I have been swimming for a while now but I dont do it more than once or twice a month.  I remember when I first started swimming (before I was full weight bearing so maybe 8 weeks ish) I could only get in 6-7 freestyle laps before my knee started hurting.  Then I put the floaty in between my legs and just freestyled with my arms.  I also got in a few flip turns too before the pain set in but after and few laps it became progressively more painful.  I didnt have much success with the breaststroke kick, that was more painful for me.  One thing I did do that was  an intense workout and also was painfree was aqua jogging.  Depending on your level of fitness you can have a floating belt of some kind of floaty on you or nothing at all.  I would alternate burst of sprinting and jogging in the water, just like you would on land, and got gassed pretty quick.  The good news is that by 12-14 weeks swimming no longer hurt and now I can swim for an hour no problem.  Like most things with this surgery, it just takes time. I don't know what to attribute the pain to, whether it is bone or muscle or just getting a new alignment though.

Congrats on your progress so far, the more success stories we can get the better.  Keep up the good work and best wishes for continued progress. Keep us posted if you can..
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on June 02, 2009, 02:28:21 PM
Hi KCuman, Good to see you back and doing so great.

Another update from me. Well my allignment has changed again!! My leg looks a total mess and not the nice and straight one i had after surgery. The bottom of my leg bows inwards and it really is horrid. Whatever caused the new movement i have no idea. I was in severe pain for 5 days and i could feel the plate moving through the tissues with any bend of the leg. It seem to be starting to settle down pain wise so im assuming the plate has made new space for itself. The pain in the medial side shows no sign of abating and to be honest i am starting to think that this is a failed op. Time is going on now and at almost six months post op i would expect some degree of the pain lessening. My  knee/thigh is still quite badly swollen and there are minor irritations/pain through the rest of it. I am not due back to see the OS until July 20th. I hope im wrong but my gut feeling is telling me its so wrong. Anyway i am off on holiday on the 11th. The crutch will join me. So looking forward to getting a break(no pun intended) I am so doom and glom,lol. Beleive me i try to be positive and still hope for a good outcome. I just want to post honestly \and accurately. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on June 02, 2009, 03:55:26 PM
Hello all,

I'm back. I needed a break from this forum. I was getting obsessed with the topic and with my surgery being so far away and being super busy at work, I decided to step back.

But tomorrow is my diagnostic arthrscopy to measure my chondral defect and assess my "good" side to confirm I am a good candidate for my DFO, OAT and MAT. If so I will have the real surgery in August.

I hope you have all made much progress. I will report back after my surgery and after I have caught up on all of your posts.

Keep the faith.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on June 02, 2009, 06:59:37 PM
Hi Tailwind,

I completely agree and know how easy it is to become consumed by your surgery and want to look up anything and everything about it. I did the same thing, and for quite awhile I didn't even know when my surgery date would be. It's nice to have you back though :)

I recently just had my DFO and tibial plateau ACI on May 18th (15 days ago). I started a post-op diary in the <100 diary section and my diary is titled "Nikki's Post-Op Diary for Distal Femoral Osteotomy & Tibial Plateu ACI - 5/18/09/" I've been trying to stay faithful to it and catch up (I've barely finished the first week), but it's been a bit hard with everything that's gone on and especially being so exhausted from the pain meds. But, I do plan to catch up with it and I've been extremely detailed in my experience and many have found it helpful. Hope you'll check it out sometime. :)

Good luck with your diagnostic scope tomorrow. I hope all goes well and you get the information you're hoping for. Keep us up to date and let us know how everything goes :)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on June 03, 2009, 07:12:54 PM
Hello out there
Chereb, if it were my leg and I was feeling like it was a mess, as you put it, I would get back in to see my OS prior to July.  Something may want to set itself in place if you wait that long.  Good luck.  Just my two cents worth.  How many weeks post op are you now? 
Nikkiluv, glad to hear your surgery is over and you are on your way to recovery.  I'll have to check out your diary post too.
I'm 10 wks now and am walking pretty good most of the time.  My PT says I should try to strengthen my quad and to do TINY single leg squats and to ride my bike.  I have been doing the recumbent but will try a spin type bike at the gym and see if that works my leg more or even try riding outdoors.  The squats are pretty tough and I'm toe touching with the good leg or I can't do them at all.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on June 04, 2009, 03:13:48 AM
Hi all

Not the news I expected today. I am not a candidate for the cartilage plug or meniscus transplants. My arthritis is too advanced and my tibial plateau is damaged from too much bone on bone. I will still go through with the DFO in late summer. My medial side cartilage and meniscus are pristine and I should get good benefits from the DFO. I will continue to post here until I start my own diary closer to my surgery date.

Thanks all!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on June 04, 2009, 02:59:59 PM
KCuman I am 5 months post op. Os has said from the last set of xrays that the joint has moved. I think it has also moved again as i have been having some real issues with the plate. Its as if it was bedding itself in somewhere else and the pain was unbeleivable. I could not even bend the knee it was that bad. I am off on holiday next Thursday and reluctant to go back to OS before. It is different here anyway on the NHS. You only get consults every 8 weeks and for 10 mins. When i go back i am going to lay my cards on the table. I dont think i should be having the same amount of joint pain this far in. At this moment in time i wish i could go back and not have had it done. Maybe i am just a slow healer? Im 37 so not overly old,lol. I am really tired of the continuous pain now. Its getting a bit much. Nothing really gets me down much but the longer this goes on the more frustrated and upset i am getting.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: lady on June 04, 2009, 08:58:37 PM
I'm so sorry to hear about your troubles. I wish there was more to say to cheer you up. You all have helped me so much with your stories I wish I could help you. I will keep you in my thoughts and hope all is well soon.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on June 08, 2009, 05:57:34 PM

I am very sorry to hear you are having such a tough go of it and I hope your holiday allows you some reprieve to decompress and enjoy yourself. Try and stay positive for an easy fix; Maybe you just have a screw loose :). Try not to think failed op unless they tell you so, there are a lot of what ifs to think about and worry yourself with. I hope you get this all ironed out and situations improve...hang in there.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on July 06, 2009, 11:02:01 AM
Back from my holidays!!! Had a great time despite the leg, should have left it at home,lol. Disney parks required use of the crutch which was a pain. Had my last physio session on return. Physio says we cant do anything else and he has got the best out of the leg. 120 is my ROM and he is pretty sure something is blocking it going further. He also says that i am probably looking at getting the allignment redone as its pretty bad! My thigh to knee is straight and then the knee sits forward and the calf curves inwards. Its very noticable and will never get a correct gait should it remain this way. I kinda knew that anyway! The joint pain is still as bad and no improvement there. I am back at OS in 2 weeks so will see what is said. Not impressed so far. I am hoping my leg can still be salvaged and there is an answer to what has happened. Its almost as if my knee has collapsed down on the realligned side. My husband finds the leg shape quite shocking. Got used to the stares with shorts on,lol. The plate also continues to be a pest. Eventually it will come out though so at least one problem resolved! Will update when i have seen OS. Hope everyone is doing great.   
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nikkiluv on July 06, 2009, 07:34:02 PM
Hi chereb and everyone else here :)

Chereb, glad to hear that you had a nice vacation, but sorry to hear that your leg isn't getting any better :( I hope that when you see your OS he will be able to provide you with some answers as to why this has happened to you and what your next step will be in finally resolving your leg and knee issues.

As for me, I've been doing pretty well. Today officially marks me being 7 weeks post-op, yayyy! The first 6 weeks were definitely rough and I wondered if I would survive, but I did, and to look back at what I made it through makes me feel empowered and so much stronger. I feel that there are very few people that are able to go through what we do and make it through the other side stronger and better, since it is such an emotonal and physical experience to go through.

I did post an update in my post-op journal overviewing the last 6 weeks of my journey. It's located under the <100 post-op diary section and is titled, "Nikki's Post-Op Diary for Distal Femoral Osteotomy & Tibial Plateu ACI - 5/18/09" if any of you are interested. :)

I know that I still have a very long road ahead of me in order to hopefully be fully recovered at the end with a new and pain-free knee, but I have made it this far and don't plan on stopping until I've reached my goal and I'm at the end. I'm hoping that the worst is officially over and now I'm just on the up and up from here :)

Hope everyone else is recovering well! :)

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on July 09, 2009, 04:20:47 AM
Hi All, Chereb, I'm glad to hear you holiday was enjoyable.  But, sorry to hear you are still having problems and your physical therapist is not able to do any more.  I'm hopeful that your OS will give you some fairly good news.  As Aturpin has said, don't give up!!
I'm now at 3.5 months (I've lost track of the weeks now :o).   Still doing PT 2 times per week and have started road bike riding about 20 miles a couple times a week.  I do use clipless pedals Tailwind and do not have a problem twisting out.  I do still notice my quad muscle is not sure how to do things.  Going down stairs I always hold on to a railing and kind of hoble down.  Also notice pedaling on the bike when it isn't right.  Other than that my progress seems good, I think. 
I tried a yoga class today and found for the most part I did OK.  I couldn't sit back on my heels, due to a pulling of the muscles just above the knee and I could not kneel comfortably.  I will ask my PT if I should push through this pain or wait.
I see my OS in about 10 days for my 16 week check.  I will ask what he thinks about surfing.  I'm still learning so fall ALLOT.

Take care all, Nikki, I will go to your post next.  Chereb, keep positive!!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on July 10, 2009, 04:27:03 AM
Hey everyone! Its nice to get updates on everyone.... I can update too!!  I'm at 18 week out and I'm doing good. I have pretty much all my ROM back. The rest I won't get back with the plate still in (about 10 degrees.) About three weeks ago my leg started bothering me a ton. Right in the middle back of my leg about 4 inches above the bend of my knee. I talked to the doctor and he said as long as I was able to walk on it not to worry to much it's probably just healing. I go back in on the 28th. (It's not as easy as it hurts lets get an appointment, I live 14 hours from my doctor.)  My IT band is tight and I can feel it sometimes rubbing on the plate, but other than that I'm doing good.

Chereb I hope the issues get figured out and you get to feeling better soon.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on July 13, 2009, 01:53:38 PM
Hi Guys, A small update from me.. Went to my GPs who had my last xray result through from consultant. The news was not good as i suspected. The joint where the weight was distributed to has collapsed. Effectively it seems the only option now is TKR sooner rather than later. I know now that the pain from the knee is caused by the collapse and no amount of physio ect will remedy it. Im quite upset as i was still hoping all would turn out ok. See the consultant next week and will update whats next now. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 13, 2009, 11:00:30 PM

I am sorry to hear that your procedure turned out this way.  Did your Dr. say why the joint collapsed?  You said that the joint where the weight was distributed to collapsed...that means that the good compartment is damaged in addition to the compartment that prompted the surgery? I suppose that explains while the angle of the joint changed so dramatically.   

You have been through so much, you are such a trooper. Try to keep your head up even though it might be hard. Best of luck at your consult next week.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on July 14, 2009, 09:54:24 AM
Aturpin....yes the good compartment collapsed. It was shifted to medial side and the medial side collapsed. Thats why the allignement has changed so much. Doctor said it was nothing anyone did or didnt do. Just one of those unfortunate things. Cried like a baby yesterday. Just seems so unfair. My consult for next week is now cancelled due to a bank holiday so waiting for a new date.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on July 21, 2009, 07:22:59 PM
Aturpin and others. Hey, now exactly 4 weeks until my DFO. Getting a little nervous and excited. Preparing to start my own pre-op diary.

Quick question: Why the ROM issues post-op from the DFO? They don't really open the knee capsule and do anything mechanically to the joint. Is is becuse they have to cut through the quad to get to the femur? Adhesions form from muscle healing post-op?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on July 22, 2009, 07:56:36 AM
Hey Tailwind.

I think my ROM issues were mostly from swelling, the muscles/tenons adjusting to the plate and scar tissue. I was put in a CPM machine at 65 degrees the same day as my surgery but I seemed to be stuck at around 75 for several weeks. My doctor didn't cut through any muscle. It was moved to the side out of the way during the surgery. The only tissue that was cut was the Iliotibal Band. 
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 23, 2009, 11:00:33 PM
Hi Tailwind,

My experience was the same as jumpi5d with respect to the cutting, only through the IT band. I find it interesting about the ROM too since there is nothing actually happening in the knee joint, as you said. The ROM symptoms, PT pain, etc. for the DFO were exactly like the experience I had with my ACL reconstruction which I also found interesting. Furthermore, after the DFO I carried swelling in my knee joint for at least a couple of months. My best explanation is that although the joint capsule isnt bothered, the entire purpose and outcome of the surgery impacts the knee joint by changing the angle so even though it doesnt seem like we are doing anything to the knee, a lot is actually happening in there. Great question though.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on July 24, 2009, 01:51:48 AM
Thanks for the info!

Here's another question. I'm thinking of buying my own e-stim machine to supplement my PT. Of course I'll ask my PT and OS about this but has anyone had any experience with thier own e-stim gadget?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: jumpi5d on July 24, 2009, 07:32:44 AM
***vent warning*** lol

I leave Saturday or Sunday for the big D to see my doctor. Hopefully everything looks good, and he can address the snapping issue from the IT band. I already know there's not much he can do for it.. It's so annoying!!!!!!! Tonight has been super rough. I did a lot of walking and now everything feels sooooooooo tight. Oh and my limp is back :-/

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 24, 2009, 09:14:12 PM

I have never personally owned a stim machine but I used to train with a bunch of people who had them and our trainers would take them along when on the road.  At the time they were pretty portable (about the size of a walkman) and did the trick, I am sure they have only gotten smaller.... its pretty much the ab shocker thing they advertise on TV. I think the only reason I would personally consider owning one is for right after surgery when your quad has to learn how to fire again and you can use it for Russian stim to reteach the quad.  As for anti-inflammatory and use while icing, I felt the stim I got at PT was sufficient.

Hang in there jumpi5d and good luck at the Doc.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on July 27, 2009, 10:21:35 PM


Ok, its been 8 mos +/-  how about a general update? How are you feeling? What is your pain level? Is the pain from your arthritis or the DFO? What types of activities are you able to do/not do?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 28, 2009, 09:06:06 PM
Funny you should ask, I was just thinking it would be time for an update.  SO in keeping with my usual format....

Post-Op Month 7 Day 22 (July 28, 2009) - it has been nearly 8 months since my surgery and I am still feeling great. If I had to sum up any differences or progress I have made since my last update or over the last couple of months I would say my knee is more consistent and I am more confident with it.  In the early stages of recovery there are bouts or relapse and pain followed by periods of comfort and gains.  As time goes on these ebbs and flows become fewer and further between and now I can't really remember my last bout of pain or weakness. Even as I increase my activity level, my knee has become harder to anger. I suppose it might be helpful to make a list of the most recent developments.

-most notably, I am no longer popping. Up until about a month ago I was feeling some catching along my medial joint line and then if I applied pressure there would be a pop and then the catching would stop.  I dont feel that anymore and it seems like the joint has kind of settled.  I dont know how much more settling I have left, I suppose I will only know in hindsight

-I was also have a decent amount of pain behind my knee, kind of at my calf insertion point, on the lateral side when I upped the activity level.  I dont experience that pain anymore.

-stairs keep getting better and better.  I am 95% confident with steps now. Simply walking up and down I am 100% fine.  Running up I am 100% but running down is a little tricky.

- I have begun to incorporate squats into my workout routine.  Granted I am doing very little, if any, weight (either kettle bell swings or mediciine ball squats with a throw) but my knee takes it really well.  If I do too much, I can tell the next day or if I do back to back days I will be sore but otherwise its pretty good. I think this is a positive commentary on the arthritis as well.  Squats used to really fire up the arthritis on my knee but now that my alignment is corrected, it can tolerate much more since there is less weight on the area.

- I have also incorporated the stair machine and the elliptical into my workout.  And, on the elliptical, I am doing sprint intervals where i try to go as fast as I can (not holding on to anything trying to simiulate running) and it does very well.  I have to stay conscious about the subject leg and make sure it is pulling its own weight though.

- I have tried to take a few jogging steps and this still feels pretty weird, kind of like I have a peg leg as there is very little push off power in the leg. I also think I am feeling the hardware in there when I land on the leg.  It will be nice to get the hardware out of there.  It doesnt bother me on a day to day basis or even during exercise but I just think it would be even better if I didnt have it.

-I am now clipping into pedals while I cycle and I have no pain or problems twisting out (can't remember who asked that before).

- I work out 6 days a week and am spinning 2 times per week... no problems there.

-I have been getting a little pain lately in my patellar tendon.  I will continue to monitor this as I am not really sure what is responsible for this.  I had an ACL reconstruction with my patellar tendon as the graft so it could be that.  It could also be overuse from cycling and or steps.  I notice it most on the elliptical so it could be an form thing.  I'll keep you posted.

-I continue to golf withouth problem although I havent played a full 18 yet (I usu. walk the course) so when this happens I will report back.

- I am also swimming from time to time, no problems.  However, I did a kickboard workout the other day and it really revealed how weak my hamstring is on the subject leg. This will be a focus for strengthening going forward.

All in all I feel that I have healed completely (my doctor might say otherwise, I am not sure how long it takes for the bone to be completely healed and the joint to settle but it feels healed).  With respect to strength I feel about 85% of my pre-op strength.  The last 15% is really in explosiveness which I am not in a real hurry to work on. I still have to stay conscious of the leg during excercise mostly to make sure it is working hard (I think that is mostly a subconscious mental compensation rather than the leg not being strong enough). Recovery is mental too, who wouldve thought.  ROM is 100% pre-op range, my quad is only a tad tighter on the subject leg but stretches to the same degree as the good leg. All in all, I can't complain. 

Lately my focus has shifted away from the DFO and towards the allograft procedure looming in my future. I am thinking I may try to do this in December again and then hopefully I will be done with knee surgeries for a long time to come (forever even? wishful thinking for sure). I will be having my hardward removed as well during the allograft procedure (2 birds 1 stone).

I hope everyone out there continues to make good progress, its a long road but so far for me, it has been one worth traveling.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on July 29, 2009, 03:03:57 AM
Excellent update. Very complete. You touched on a lot of things I was thinking about. Again, key point for me is not to focus too much on any given day and take a long view of recovery and rehab. Also key: leg strengthening takes a long time with a  DFO. Pre-op, I estimate my subject leg is 60-65% as strong as the good one. It will take a long time and a lot of work post-op to match the good one.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on August 06, 2009, 10:13:14 PM
Watching the CD of surgery vids from my surgeon and just realized the two surgeons on it are mine and Dr. Bugbee.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 07, 2009, 07:20:48 PM
ooohhh, bitchin..... I'll bet it pretty gnarly to what huh? If you happen to have that digitally that would be cool to see.  It would be neat to see my Dr. in action.  I'm jealous your surgeon gave you that.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on August 07, 2009, 08:42:06 PM
I find it fascinating. There are two in particular I have watched over a bunch. They are both combos of DFO and OAT and MAT. I watched them because I was a candidate for the DFO/OAT/MAT triple whammy, but now I'm just having the DFO. They don't show much of the DFO on the vids but reallt get into the OAT and MAT. Its sort of like watching someone take apart and rebuild a lawnmower engine. You can order a copy from Dr. Cole at
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 08, 2009, 12:04:00 AM
Thanks for that.  I have OAT procedure coming up in my tour of knee surgeries so I am glad they show a lot that.  Maybe I dont want to see it before the fact on second thought  ;)?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on August 08, 2009, 01:11:10 PM
For me, knowledge and info is how I maintain some "control" in this process. The more info the better, even if its tough to watch.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 18, 2009, 08:05:34 PM
Post-Op Month 8 Day 12 (August 18, 2009) - I have another update of sorts.  Up until this point, the only activity I had really not attempted since my DFO was hiking.  And I don't mean walking, but really hiking.  I have been nervous about how my knee would handle it, esp. the descent as it is pretty much like going down a neverending set of stairs. Well, this last weekend I did a hike alright. My boyfriend has been suggesting we hike the Grand Canyon in the Fall but wanted to test his fitness/my knee by doing a test hike.  The hike he mapped out, which was misrepresented to me as "challenging but no big deal", was to the highest peak in Orange County, CA. Details of the hike are as follows:

17 miles roundtripÖÖ8.5 up, 8.5 down
We parked at 1,716 elevation, the peak of the mountain is at 5,687 feet for a total gain of 3,973 feet in 8.5 miles.
I would love to say that I made it all the way to the top.  But, for fear that I might not be able to make it back down, or that I might completely thrash my recently altered knee, I turned back at about 4,650 making my elevation gain about 2,934 feet.  I cut about 2.5 miles off the distance as well making my hike about 14.5 miles.

In short, I was really proud of my knee!  In hindsight, it wasn't necessary that I turned around, my knee would've help up to the top and through the descent.  That said, I am glad I did turn around.  I don't think it is wise to have my first hike back be that intense, esp. if I would've gone the entire way. My knee got a little achy about 5 miles into the hike.  On the pain scale (1-10) the pain reached about a 6-ish around mile 5 and maybe hit 7 by the time I was done with it all.  I was nervous at mile 5 that if my pain was already a 6 then I was going to be in trouble.  I was pleased to discover that the pain leveled out. The pain I speak of had very little if anything to do with the DFO and was mostly arthritis related.  That said, I am getting some interesting pain around my medial compartment.  Given cherebs experience I will montor this closely. I also experienced a significant amount of muscle fatigue by the end of the hike.  Judging by my boyfriend's comments upon his return, I don't think my fatigue was any more or less than a normal person. 

The next day there was nothing more sore than my calves. Both of my knees are sore but the subject knee feels perhaps a little more sore simiilar to the soreness I get after overdoing it at the gym (maybe if I did lunges or too much stairs, things I really shouldn't be doing too much of in the first place). I don't know about the Grand Canyon at this point... whether I am fit enough or whether it is even prudent to do is TBD but I am glad I got back on the mountain and pleased my knee did alright. Before surgery I did a hike that was much much steeper and shorter and I really struggled on the descent.  I expect that if this hike had been steeper or the same elevation crammed in a shorter distance I probably wouldve had more pain and struggled mightily. I'll save that hike for a much later date.

In general update news, I feel I have hit a mini road block of sorts since my last update.  I am all around just a little more achy than I have been in the month or two preceeding my last update. I had been doing quite a lot of activity and I think it just added up. So, I have tried to scale back a little and it seems to be helping. As I said before, the hurdles are more subtle and fewer and further between, but they still exist for me at this point. As I mentioned before, I am having some soreness around my medial compartment and am also having interesting patellar tendon and patella pains.  Some of it feels like tendonitis and some of it feels like the pain is coming from the back of my patella.  I seem to remember my doctor telling me that I had some signs of wear there so that makes sense.  I wonder how much of the pain is from the joint adjusting to the new angle and how much is something I should be concerned about... only time will tell. Even in my more sore state, I was able to complete a challenging hike, do a 15 mile bike ride and play 14 holes of golf in a 3 day period. So I don't have a lot to complain about and am grateful to be tolerating as much activity as I have. Nevertheless, just wanted to let people know I still get sore and achy and I am still working out knee issues.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on August 20, 2009, 11:00:55 PM
Good to see you still posting Aturpin. I hope your aches and pains are a bit better. You go girl!! Hiking!! I am impressed. I am getting worse by the day. Its a struggle to walk anywhere at all and have been relying on my crutches more and more. 3 weeks today i will undergo the surgery again. Fingers crossed i get a good result this time!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on September 16, 2009, 04:35:16 AM
Hello All
Tailwind, you have probably undergone your surgery by now.  I hope all went well and you are recovering well.  Chereb, good luck with your next surgery.  Aturpin, thank you for the updates.  I have been out of the picture for a bit and it is nice to get back to this and see how you are progressing.  You are about 3 months ahead of me, both having the same dr. and you being ~20 years younger I like to see what you are going through and activities you are doing.  Thank you

A little update for me, next week is 6 months.  I would say I'm about 80% or more.  For most of my day to day activities I canít even tell I have gone through a DFO.  Going up stairs my quad seems to have to work a little more, going down I tend to hold the railing just to make sure I stay vertical, although I donít really need it. 
I am back to road bike riding, using clip pedals without problems, I go about 40 miles riding some hills in so Cal.  Aturpin I did have some patella tendon pain at times during my ride, more earlier than now.  I have had to adjust the seat height up some and will try that next week to see if that helps some.  I did some mountain bike riding last weekend and the rough terrain did not bother my leg.  Iím doing kickbox classes 2x week at the gym, I donít go all out with the high impact and I do still feel some pain, different than prior to my DFO.  It is along the outside of my shin, maybe old nerve damage in the knee box side affects.  Aturpin, do you feel anything like that?  I probably should ice after activities but most times do not.

My quad feels much stronger than it did 2 months ago.  I can walk downhill without limping or even favoring my surgery leg.  I do notice if there is a cross slope that bothers my kneebox which my PT said I should avoid. 

Dr. Bugbee told me at 4 months that he didnít need to see me again until I hit my one year date.  Aturpin, he told me he would not remove the plate unless it caused me problems.  Is yours bothering you?  Mine doesnít other than I have a bump on the side of my knee now.

Iím considering trying to run at 6 months.  Nothing major just try.  I havenít yet.  Dr. said wait at least 6 months.
Thanks for listening
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on September 21, 2009, 05:29:10 PM
Hi Karen,

Happy anniversary!  Six months is a great milestone.  Thanks for the tip on the seat height for patella pain.  Most of mine has gone away (at least recently) but I am with you, I think it is positioning on the bike. I am glad to hear you are doing kick box classes... I have been wondering how the impact of hitting a bag would feel on the leg.  Also the torque that could be on your leg in some of the kicks could also be pretty intense.... good for you to get back at it. 

To answer your question, I don't have any pain along my shin and haven't experienced that to date... sorry I can't provide insight on that one. As for the plate, mine really doesnt bother me.  On a scale of 1 to 10 (10 being completely bothered and in pain and 1 being I dont know its there) I am at a 2 or 3.  I get a little achy over the plate area after vigorous exercise (I assume from the muscle rubbing along the plate) and I feel tightness in the muscle over the plate when trying to sit on my heels (almost like the muscle is getting caught up on the plate but not painful). Also, I can kind of see the bump on the side of my knee too...its kind of annoying at times.  I am having another surgery for my cartilage and he is going to remove the plate then.. however, if i wasnt having another surgery, I probably wouldnt schedule one just to take the plate out, it certainly doesnt bother me that much.

I try running from time to time but only for 10-20meters max.  Just to see what it would feel like.  It is better now than it was say 3 or 4 months ago but absolutely does not feel like before surgery.  I think if I actually did it with any regularity or distance I might feel differently, I will be curious to hear how it works out for you. Be careful and have fun! Congrats again!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on September 25, 2009, 03:55:13 AM
Hi Aturpin,
I chickened out with my run yesterday because my knee has been a little sore after my weight lifting class at the gym a few days ago.† I use only 3-5 lb weights i think it is the motion more than the weight.† To many pleeaa (sp?) squats i think.† Anyway, a little sore in the medial side.

The kickbox class I do is at air, we don't use bags so I have not experienced kicking a bag.

That's it for me.† Take care all

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on September 25, 2009, 07:46:22 PM
Hi Karen,

I hardly think you chickened out, I think it was wise and prudent.  If there is one thing this surgery teaches you is to know when to push, know when to lay back, and listen to your body.  If you are sore from plie squats think how sore you wouldve been after a run.  You'll be running again one day soon, when its right, till then happy kickboxing, cycling, and weightlifting.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: steveHa on September 26, 2009, 06:17:18 PM

I had a DFO coming up for about a year ago now (end October 2008) and have really found it quite interesting reading what you've gone through.

I've been having some discomfort with my plate since it's been in there (and really can't wait to be rid of it), but have managed to run up to about a mile before may leg feels like it's really had enough. I started running after about 6 months and have taken it fairly steady, as it's very odd getting running again and feels completely unnatural now, but i used play rugby and really miss the running.

I was really surprised to hear your doing martial arts - kick boxing - does this cause you any pain? Did your doctor/physio suggest this as a good exercise? I've been looking for low impact types of sport that i can take up, and i'm really intrigued that your doing this!

I hoped you may tell me about your experiences with a few things that i've noticed about my own recovery and wondered whether it's just me or if you've experienced similar things,  as it's very difficult to know whats normal after this type of operation.

Firstly, when ever i get up in a morning and first stand up, my ankles are really sore for a few minutes. I'm not sure if it's to do with the re-alignment and my legs still getting used to things, but i'd have thought this would have all settled down after 11 months. I never had this soreness before my op.

Secondly, do you have much in the way of scar tissue? I get quite a fair bit of discomfort from around my plate which I think is caused by the scar tissue. It almost feels like there are ball barings beneath my skin rubbing over each other and doesn't quite feel right when ever i straighten my leg. Do you still have much in the way of scar tissue or anything like this?

I'd really appreciate any comments you have and good look with your continued recovery. I hope you get yourself running soon.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on November 05, 2009, 10:47:08 PM
I am constantly referring to this diary and Aturpin's experiences at a particular time post surgery. When I see that, for example, she was still limping while walking 11 weeks after surgery, I don't freak out that I am limping too. This is the best DFO diary ever!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 06, 2009, 05:08:56 PM
Hi Geeks!

I am sorry, I have been terribly remiss at my diary duties lately. Tailwind, thanks for the shout out.  It makes me feel great to hear such positive feedback. My initial intention when doing the diary was to accomplish exactly what you are getting out of it so I am just thrilled you are benefitting.

To steveHa:  I am sorry I have not replied to you and I hope you havent given up.  It seems we are only about a month apart in our recovery stage.  I am really surprised to hear you were running after 6 months.  I am still not running and, if you have read much of this diary you know, that I will likely not ever do much running.  Nevertheless, I have done some light jogging just to get a feel and I agree wholeheartedly with you about it feeling unnatural.  It feels like running with someone elses leg or even a prosthesis.  I have noticed not only in running but also in other activities that the subject leg lacks explosiveness in a big way. its like its sleepy or something. I continue to work on this and, to this day, focus extensively during exercise on making my subject leg work and do its part.  If I dont, my brain easily begins to compensate. As for the martial arts, I think you might have been reading a post someone else made to my diary.  I have only done one cardio kickbox class, no bags, and I only stayed for 40 mins because the movements were a bit awkward for my leg. I have considered doing this with punching bags and the whole thing, however.  And, I think that it would probably be ok on my knee so long as I took it slow in the begining and stayed away from jumping or high impact moves.

To your specific questions:
1) I have not experienced what you are experiencing with your ankles. That could be for many reasons including the number of degrees we had corrected.  If your correction was more dramatic, it would make sense that you may need longer to adjust.  I would really chalk this soreness up to your legs adjusting to the new angle as you said.

2) as for scar tissue, its hard to tell.  I can feel a bit of a speed bump over the top part of my plate that could very well be scar tissue. I think I have been fairly lucky with the whole plate discomfort thing. I really dont get too much agitation from mine.  I think different doctors use different sized plates. Perhaps if yours is larger it may be more of a nuisance.

Although I cannot really comiserate with your specific issues right now, I think we all have our little hangups that are unique to our biology especially as we get further along in recovery and introduce more activities. If you have other questions or issues I would be happy to comment given my experience.  I am usu. more diligent in keeping up with posts so fire away.  Good luck to you and best wishes for continued improvement in your recovery.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 06, 2009, 05:23:02 PM
Post-Op Month 11 (November 6, 2009) - Happy 11 month anniversary to me!  I can't believe I am coming up on a year now since surgery. I thought I would give an update since it has been a while but also because I saw my doctor last week.  I really went to go see him regarding the cartilage procedure I have in my future and to get his opinion on if and when that should be done.  More on that in a minute...

We took xrays and everything is still glued together.  You can see where the bone graft was placed and the wedge and he said that you will likely always be able to see it, kind of like a scar.  But, the bone has healed fully and the surgery was a success.  I have gotten feeback from family and firends who have commented that I am capable of doing more now than I was before surgery and that I also appear to be in less pain.  It has been such a long road for me personally that it is difficult for me to remember how I felt pre-op so hearing objective feedback from others is helpful to me. I continue to be active and aside from running, am doing everything I want to do. In fact, I am spending so much time on the bike now that I decided to get certified to be a spin instructor and just completed the certification last week. All in all, I am pain free....even the arthritis isnt acting up much lately, not for months now. I experience the most discomfort when hiking for long periods and that usually goes away by the next day. Stairs are fine, I can run up and down. Squats are good, lunges are fine...all in moderation.

As for my next surgery, I am scheduled for an arthogram (xray with contrast) and MRI for next week to see how my carilage is doing.  In some patients, when the pressure is taken off the defect via osteotomy, the knee grows fibrocartilage on its own.  If this is the case for me, no surgery this year.  If not, we are gonna go in and fix it via allograft. I feel good about deciding to have surgery this way rather than just going for it to get it over with.  I am trying not to form an opinion as to whether or want or dont want to have surgery. Obviously I dont WANT to have surgery, but I know I have a problem in there and I know I will eventually need to take care of it. Now its just a matter of timing. 

I hope you all are doing well and coming along nicely in your various stages of recovery.  Keep up the good work and stay positive. TTYS!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on November 11, 2009, 01:25:13 AM

Thanks for the update. I recall that your timetable for the next procedure on your knee is approaching. I hope you get the answers you want in your upcoming exams. I am jealous that you have additional options for your cartilage issues.

I have a specific question. I clearly have arthritis pain when doing stairs and single leg, full weight exercises. Its not the most horrible arthritis pain I've ever had, but its annoying and, frankly kind of surprising considering I just had a major operation designed to eleviate this pain. But I also realize that this is a looong rehab and I'm only 12 weeks post op and that my leg is slowly getting stronger......

So my question is, did you have arthritis pain in your knee at this point in your recovery and did it get better as your rehab and recovery progressed and your strength returned to your leg? After re-reading your diary, I think the answers are yes and yes, but sometimes you were not so clear about exactly where you were having pain. Right now I would say I have no pain associated with the surgery site. All of my pain is lateral knee pain.

Talk me off the ledge......
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 11, 2009, 06:51:20 PM
Hi Tailwind,

Deep breaths, its still early in your post-op.  Truth is, I remember very clearly having more pain associated with arthritis than I did with the osteotomy, particularly after the first month or so and the site had healed up. The catch 22 about this procedure is that its goal is to help alleviate arthritis by displacing the weight evenly on the joint, blah , blah, we know.  But, the procedure itself results in significant muscle atrophy.  Without the quad muscles available to absorb impact and stabilize the knee, the joint takes the brunt of the work.  As you build your quad muscles back, less pressure will be on the knee joint and the pain will diminish. Also, I remember talking to my doctor about my "arthritis" pain and he told me that a lot of the pain I was describing was from the joint realignment and adjustment.  Its an interesting ride over many months, maybe even a year, where you will get different pains in different places just randomly for a day or a week or so and then they go away.... as was explained to me, all part of the joint adjusting to the new angle and what you may think is arthritis, may actually be from the joint adjustment.

To be clear about the pain I was having, it was all in the joint (after the initial month or so of course)... no pain at the surgery site.  Sometimes it was medial pain, sometimes patella, sometimes lateral. My defect is in my lateral compartment so I naturally associated the lateral pain with the defect/arthritis. Also, I had an opening wedge (I think you did too but cant remember) so the type of osteotomy will also impact where you have your pain. Right now my arthritis really doesnt bother me much.  And, when it does flare up I usually did something to provoke it and it usually subsides the next day or two...much improved from pre surgery.  Keep working to build you quad, hamstring, hip and glute and the pain should improve.  Hang in there....
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 10, 2009, 12:03:50 AM
Well folks, it has been one year since surgery.  I only regret that I didn't notice it 3 days ago on the actual date of my anniversary and posted what I am about to post.  I suppose that is a testament to how I am reminded of my knee less and less as time progresses.  9 months ago I could tell you how many weeks, days and hours had passed since surgery.  So, my big news.....

I met with my OS regarding the possibility of having another surgery to repair my cartilage defect and he suggested that I have another MRI with contrast to check in on my defect.... is it bigger, smaller, healing, worsening?  He said that some patients experience a regrowth of cartilage, allbeit fibrocartilage (similar to the cartilage microfracture produces) not hyaline cartilage (what we are born with which is best), after unloading the impacted compartment.  He said that if I was one of those patients, we wouldn't need to fix the cartilage just yet and will continue to monitor it over the coming years and consider surgery if my symptoms worsen or the defect changes for the worse.

SO, I had the MRI and sure enough, my defect is improved.  He said it appears to be shrinking slightly and there appears to be some cartilage regrowth, erego, no surgery for me this year.  I dont know if I am more excited about not having surgery or that my knee is trying to heal itself... probably the latter (and, I cant help but wonder if taking glucosamine and chondrotin has been helping, who knows?). I can expect continued improvement over time as well (assuming I dont do anything stupid...big assumption).

I suppose this is the punchline of my ordeal:  I had a DFO and as a result have seen improved function, less pain and improved health of my knee. If I never made another post, this is all you would need to know about my experience. It worked.

Only time will tell if this will stave off a knee replacement or ultimately change the path of my knee (I may very well end up with a knee replacement at 50 regardless and we'll never know how long my knee wouldve taken me without the DFO), but, I can look back today and say that I am glad I did the surgery and I think I am in a better position now because of it. I will continue to post periodically because I am as curious as the next person about real long term results - 5 years, 10 years, 20 years. Although 20 years from now they will probably just rebuild a new knee with stem cells, it may provide someone somewhere some insight.

Good luck to all of you post-op DFO'ers out there and thank you to all of you who have shared your experiences for my beneft. To all of you considering this procedure, I hope that my experience eases and informs your decision making process.  It is a big surgery and big decision but, in my opinion and experience, worthwhile.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on December 10, 2009, 02:44:39 AM
Bravo! Bravo!

SO happy for you to hear this news. I had not heard about this phenomenon until you described it here. And I thought I new everything about DFOs.

I wish you and your knee many many years of health and I hope you do follow up from time to time to let us know how you are doing. I am reminded, however that for many people, once your knee feels better you tend to ignore this forum and focus on the other things life has to offer. So I will cut you some slack if don't come around as much.

Thanks again for sharing your experiences here. You got me through many anxious moments.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on December 10, 2009, 08:28:00 PM
Thanks Tailwind.

I promise  not to disappear and will give periodic updates.  One thing is for sure is that I will be monitoring this knee annually and I also have a ton of hardware in my knee... these will be topics of note in addition to my overall well being. Will also check in to see how you and others are doing and answer any questions if they arise... dont hesitate to ask, of course. Till then....
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: boysmum on December 11, 2009, 05:43:15 PM
Great news, Pleased to hear you have done so well!

Hope things carry on the same for you

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: KCuman on January 05, 2010, 05:00:47 AM
Aturpin that is great news on the Ďcartilageí re-growth.  I had not heard of that either and did not know that was a possibility for us DFO patients.  I am just over 9 months post-op DFO by your OS and have days I donít have a reminder that Iíve had the surgery.  And, there are days that my knee does Ďtalk backí after an activity.  After reading Tailwinds recent posts I thought more about my current knee discomfort and Iíd say it is in the lateral compartment not the surgery area.  I have damage to the articular cartilage in the tibia plateau and not much if any arthritis.   The discomfort now is much less than prior to surgery but still there.  I did go downhill skiing and my surgery knee handled itself fine other than a couple twinges getting off the chairlift again in the cartilage area not surgery.  I see the OS in March, I too will ask for an MRI to see if my cartilage damage area has improved.  Other than that, just continue to go through with the Ďadjustmentsí of the new alignment. 
Does anyone use a foam roll to keep the IT band loose? 
Keep up the good work everyone
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: hannah17 on February 20, 2010, 01:35:59 AM
Hi Im Hannah
        Im 17 years old and i will be having a distal femoral osteotomy on march 2nd. I've torn my meniscus twice playing soccer and i guess i have no lateral meniscus left. I guess Im just wondering what to expect. I live out by Chicago my surgeon says ill be over night and ill have a plate and 6 srews in my femor but other then that i really dont know much about what to expect. I'm really wondering mostly how long my scar will be and how long you think i would be out of school. I'm just really nervous.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: mmrocker13 on February 20, 2010, 05:04:55 PM
Hey hannah...I responded to your post on the other board, if you want more info. But my incision is about 7 inches, I have 8 screws. I don't know much about your case, but do know that this procedure is an end-stage procedure.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: hannah17 on February 20, 2010, 06:05:41 PM
Thank you soo much
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 17, 2010, 09:27:57 PM
Well, it has been another five months since my last post which kind of summed up my experience.  In keeping with my promise to not disappear, I thought I would make a quick update post.  Also, as some of you might remember having followed my posts, last August (about 9 months post op) I attempted to summit the highest peak in Orange County California, Santiago Peak, (4,000 feet (1,200 m) in elevation and is about 16 miles (26 km) round trip) and didn't quite make it.  I was pretty achy about 6 miles in a decided to turn back early to make sure I could get down.  Well, yesterday I went back for revenge and conquered.  My knee didn't bother me one bit and I was so excited and surprised by how much difference another nine months made.  Rest assured all of you post-opers out there, you continue to progress over a long period of time.  This isn't a light surgery and the recovery takes a while. I am much stronger now than I was when I last attempted this hiike and I think that strength took a lot of pressure off the joint. I have to say that I still noticed some differences between my two legs, especially on the decent where that eccentric movement really highlights a weak point in the leg (like going down a ton of steps).

Also, I have been seeing a massage therapist periodically over the past few months to help with my IT band and scar tissue.  With all of the trauma done to the knee, I have some pretty solid knots/trigger points in the vastus lateralis that I can feel while Im working out.  Also, the weakness in my hamstring and adductors has caused other muscles to be recruited and everything is just a bit out of balance.  I feel like this has helped me regain a bit more functionality by breaking up some of the tightness. Granted I would have gone on fine without it, but, it may be worth considering for those of you out there who want to get back as close to normal as possible. Also, I should say that "massage therapy" is not the kind of spa-esque experience one thinks of when they hear massage.  This is a lot of digging, deep breathing and eye tearing up stuff.

Aside from that, I have no other news to report.  Things carry on as they have.  I continue to spend the majority of my exercise time on the bike while continuing to golf, swim, practice yoga, hike, do stairs, etc.  Still no running and no real plan to.  I tried to do a beach workout about a month ago that included some jogging on sand... while it went fine while I was doing it, my knee was sore for about a week afterwards... just not worth it. Keep on keepin on.....
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on May 17, 2010, 09:31:45 PM
I stand corrected... the peak of the mountain I hiked was 5,689 feet.... i want all the credit i can get :).
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: crankerchick on May 18, 2010, 12:39:56 PM
Woot! That's a great update. Very encouraging and inspirational. Congrats on the victory!

Rest assured all of you post-opers out there, you continue to progress over a long period of time.
This is something I really needed to hear today. I'm almost 7 months post-op from derotation osteotomies and sometimes it feels like strength is coming back so slow, like it may never happen! Very encouraging to know that gains are still made this late, and later, in the game.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tailwind on May 19, 2010, 06:23:19 PM
Thanks for the update.

I am going to post a 9 month update soon that mirrors a lot of what you reported!

Glad to hear you are doing well.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on September 29, 2010, 11:29:35 PM
Hello fellow DFO'ers (HTO's and all other variations too!)

It has been about 4 months since my last update and I am 2 months away from my 2 year anniversary.  2 years!!!! Thats crazy... time flies.  So I thought I give a quick update and I have a bit of good news to report. About two weeks ago I completed my first triathlon.  I am an ex sprinter/heptathlete so I figured the multi events in track might lend nicely to triathlon. Plus, I have always wanted to check it out and see what the fuss is about. The triathlon I did was a sprint (.5 mile swim, 12 mile bike, 3.2 mile run) and I swore before I allowed myself to signup that I would walk the run. I dont have anything to prove anymore and Im not in any rush to wear through what little cartilage I have left and jump on an OR table. I stayed true to that committment excepting the first 200 meters (cant walk out of the transition zone!) and the last 1/4 mile (cant walk across the finish line either!). The parts I did run felt great, so nice to be running again and no pain. I finished 4th in my age group and won the bike leg (kind of funny considering how much time I spend on the bike now vs. pre DFO, it certainly has positively impacted my ability there). I iced the knee that night and felt pretty good the next morning.  Hiking actually leaves me more sore than the sprint tri did. I really enjoyed myself and am aiming for an offroad/mountain sprint tri in November.

So, as you have probably gathered by now, things continue to go well.  Any knee pain I have is purely related to my cartilage deficiency and I dont believe any to be DFO related. I am looking to see my OS around my 2 year anniversary for another MRI with contrast to check in on how that cartilage is doing.  I still have a cartilage surgery in my future but the DFO has succeeded in buying me some more time.  Ill report back with news on the MRI. Hope all of you post opers out there are doing well and being diligent with the PT.  Good luck to all of the pre-opers considering the surgery... its not as bad as it seems.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on October 30, 2010, 08:38:37 PM
I am new to this blog and hope this posts correctly.  First I would like to thank all of you for your input, especially Aturpin.

I am 58.  At 49 I had pretty much all of the meniscus taken out of my right knee, arthritis already present.  OS told me never to run again and that I would probably have a TKR within 5 years.  I ran for 8 more years, slower and shorter distances.  Still bike about 6000 mi per year, not nearly as fast as I used to.   Sigh. 

About a year ago I gave up running becasue ot the knee pain.  I still bike, but in the last few months the speed, distance and frequency have decreased.  I'm ok when I ride but get sharp pain afterward if the muscles get tired.  Then the short shots of pain started showing up if I did something like twisting  my knee.  MRI and x-rays show medial compartment of the knee is OK, but I have Grade III and IV chondomalacia in lateral compartment and that I have worn the lateral condyle flat.  My Tibia and Femur are at a 10 degree angle, knock kneed.   

Here's my issue. I can lead a life that a lot of people my age would consider normal and the pain is well within bearable limits.  The doctor has given me two choices, DFO now (the wear is so bad, I can't wait) or wait until the pain becomes unbearable and get a UKR, timing unknown, although I'm told pain associated with lateral compartment arthritis increases like "falling off a cliff".  I want to be as active as I can for as long as I can.   If I am to have a DFO I am pretty much have to decide now.  You folks have been through it.  Any advice?
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 08, 2010, 10:13:17 PM
Hi Tomas52,

This is a really interesting question you pose... hard too. Although you might feel between a rock and a hard place, your age makes your position better in some respects. For many of us, we have resorted to DFOs, HTOs, etc. because we are too young to have knee replacements... we didnt have much of a choice in terms of surgical options. At your age, a knee replacement would be within the realm of realistic possibilities, thus the choice you have in front of you.

While I have always heard, and my doctor has reitterated, it is best to keep the original parts as long as possible, surgery at 58 can be more difficult to recover from. For a DFO to be successful, your body has to grow its own bone to fill in the may have read on some other posts that this is not a guaranteed phenomenon. If that doesnt occur for you, you will likely have to undergo another surgery (probably and UKR at that point). The way I see it, your choices are as follows:

1) opt for a DFO to buy yourself some time before a UKR. The recovery is long but if it is successful, you should experience some solid relief from your pain over the near term. If the DFO doesnt take, worst case scenario is you have the UKR (and you have to have another surgery :( ). Suppossing you live a long life, you may have to have two UKRs in your lifetime (I have been told they last about 10 years or so).  If you do the DFO and it is successful, that means probably one UKR in this life. Either way you may be looking at 2 surgeries.

2) Have the UKR off the bat and see if you can get away with only one but recognize you may need two. I have heard the recovery from a knee replacement isnt so bad (probably easier than the DFO). I am not too familiar with knee replacements so Im not sure how much your activity will be limited; you should obviously look into this. I assume you can ride a bike, swim, hike, etc. (all low impact activities).  You probably shouldnt be doing any running, tennis, pounding activities with either procedure so Im not sure if there is a difference in functionality with either of the procedures. Can one get on with titanium parts as well as normal parts?  I have no idea but I am sure there are people who can share their experience with you.

As I see it the decision is between keeping your original parts as long as possible at the expense of a 6 month rehab process and fairly intense surgery vs. trading in your original parts and maybe compromising some long and/or near term functionality.

I would ask your doctor whether he/she thinks a DFO can put off a UKR entirely.  If so, I would strongly consider it.  If not, ask your doctor if he/she thinks you will have to have more than one UKR in life (he/she will tell you it depends on how you treat it but try and pin him/her down to an answer). If more than one, it might be worth doing the DFO as you have to give up a lot of bone to do multiple knee replacements (to my understanding). I would also get multiple opinions from surgeons about the best course of action or at least what you can expect from each procedure.

Bottom line: If you want to be active for as long as you can (as you said in your post), ask your doctor/s which route will give you the best chance at that outcome.

I hope this was remotely helpful.  Good luck with your decision, if you have any questions about the procedure or the rehab I would be happy to give you as much information as you need.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on November 09, 2010, 12:54:12 AM
Thanks Aturpin

You've been an inspiration.† It's wonderful that you wrote as much as you did, and attracted so many comments from other people.† You may not believe this now, but 58 is VERY young.† But some day you will believe it.† †I do understand the possibility of the femur not knitting together.† Remember that aniother big consideration in the whole healing business is general state of health and fitness.† And there aren't may 20 year olds who are as fit as I was a few months ago, but the longer I wait, the less fit I get.

I believe that no matter what I do, I will have at least two major surgeries on this knee.† I trust my ortho implicitly.† He does not think I am in enough pain now for a knee replacement, but the lateral compartment of my right knee has no gap and is basically Grade IV, and so if I am to have a DFO, it cannot wait.† Strong muscles are all that have kept me going for years, but the pain is discouraging me from the kind of exercise that it takes to stabilize the knee, thus a vicious downhill spiral.† I have a number of friends who have had knee replacements, and if I were a normal person, that's probably what I would do.†

But I'm not a normal person.† I know that nothing I do will guarantee that I can go back to doing what makes me happy, but my ortho has told me that I have a DFO is basically the only shot at it.† His assistant is still playing singles tennis 19 years after my Dr gave him a DFO.† That's pretty lucky, I think, but out of the question with a knee replacement.† He tells me that if I want to run, a DFO is my only chance.† And much though I would like to run, going on adventures is what I want most.† In the last 40 years, I have been in 71 countries and 48 states.† And every trip I have been on has been strenuously physical.† I have had the most amazing adventures in my life.† I can't sit by a pool and drink Mai Tais.† And the knee is in such poor shape now, there is no way I could go anywhere satisfying.† I need a knee I can rely on.

So I look at a DFO as doing two things.† One, even though the recuperation from a DFO is 6 months of low quality life, waiting for a replacement would be more like a year or two of low quality life before the ortho would do the replacement.† I can no longer bike more than 15 miles without a serious risk of a bad evening of pain.† So any sort of daily life or adventure I would enjoy is basically out of the question for the next couple of years if I wait for replacement.† And I would probably push things too hard and make a further mess out of my knee.†

So two, it seems to me that a DFO at least gives me a shot at doing something satisfying for the next ten years, things I couldn't do (apparently) with a mechanical knee.† And if ithe DFO fails, well then I'll probably have a replacement at about the same time I would have had it had I just waited and not done the DFO.† And as opposed to youngsters like you, if I get ten years of quality life out of a DFO, that's probably 50% of my actuarilly remaining life span.† Morbid perhaps, but certainly a consideration.†

My doctor told me the following.† The reason I'm confused as to what to do is because there is no right answer.† He told me to get as much information as I could, then "put on a pair of rose colored glasses , find the place I feel comfortable, and go for it."† In other words, there is no guarantee about anything in life.† And so I have chosen to gamble on having some more wonderful adventures in my life, and if I lose the bet, well, at least I tried.†

The DFO is scheduled for December 9.† And believe me, I have thought many times "what the *** am I doing?"

Thanks for writing.† Any hints on things you would recommend to make recuperation in a Wisconsin winter living alone more bearable?†

I have to say the thing about your blog I found most amusing is that after two months you said it felt like two years, but after two years you said it felt like time had flown by...
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 11, 2010, 01:24:23 AM
Hi Thomas,

Wow, it was a real pleasure reading your reply.  You have really given this the thought and consideration it deserves.  Halfway through your reply with all of the color of your level of activity, life experiences, life goals, aspirations, etc. it was a clear homerun for me that you should do the DFO. Then, at the end of your reply when you said you had a surgery date for a DFO, I was really excited to see that.

I feel like there are two types of people who end up in our situation... 1) the never say die, push it to the limit, thrive on activity kind of person, and 2) the genetically less lucky in terms of the physics of the body.  For the most part, Id like to think that 90% of people in our situation fall into Group 1, we all got ourselves here with our lifestyles. That said, based on the blogs I have read, I feel as though those in Group 1 have a greater likelihood of success with this type of surgery because they approach the recovery and rehab with the same fervor and intensity that got us there in the first place. This type of surgery needs that kind of approach to be successful... so long as the patient is compliant with Drs instructions and doesnt push too far. I say all of this because with the information about your activity levels, fitness level, health, etc. your probability of success with this procedure is greatly improved. Capitalizing on your fitness and health right now is a great strategy in my opinion. I also didnt realize how long you would have to wait to have a knee replacement...I agree with you about that being a huge downside for all of the reasons you stated. I like that you are willing to roll the dice and for the amount of upside there is in this scenario, it doesnt seem like such a risk.

As for advice, if you came across one of my posts, I talked about nutrition during my rehab process, I think that coupled with attitude goes a long, long way. No question a Wisconsin winter is a tough time to be on crutches. If its not too big a dent to your ego, you may want to seriously consider a wheel chair for some outings... you really dont want to risking slipping in the snow/ice on a freshly operated on knee. REALLY!  I have read many instances (and had a couple myself) where I slipped and used the subject leg to catch myself only to feel lots of pain, worry and fear about what could have possibly happened.  I cant stress rehab enough, whether at home or at a PT center. Patience for sure.  Thats all that immediately comes to mind.  I think there are some other posters that have had to endure similar circumstances during their recovery, you may want to hunt through some other blogs. As you so insightfully pointed out, the first little bit will feel like an eternity but in the grand scheme of things, its a small blip of time. Good luck and if you feel so inclined, Id love to hear how it all turns out for you. If I can be any more of a resource to you, please feel free to reach out.

PS I apologize profoundly if my post came across as especially age-ist.  I really do believe 58 is very young, especially your kind of 58.  71 countries and 48 states is representative of the type of life I aspire to, kudos to you for accomplishing so much.  :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on November 11, 2010, 02:23:59 AM
I had to laugh when I read your response.  After reading the blogs, and thinking about things a little, ok, maybe more than a liittle, I have been trying to get the Ortho to say the following things are "medically necessary".  He gave on one, a hospital bed.  I only have one bed in the house, and it's on the second floor.  I intend to live on the first floor for the first couple of months, even though it means sponge baths, not showers.  Or maybe crawl up on my butt every once in a while for a shower.  I have been on crutches twice before, and climbed stairs, but with a cast on I wasn't so worried.  When I broke my ankle, I had my cast bingie corded to the pedal of an exercise bike 4 days after the break, with the doctor's blessing.  But with what is essentially a broken femur, even though screwed and plated. the risk of climbing stairs seems too high.  so hospital bed in the diniing room.

I also read about people's fears of getting on a regular exercise bike.  I hauled out my old crutches and gave it a try with one of my bikes on a wind trainer.  That is also too dicey for me.  The Dr. would not approve a recumbent exercise bike as medically necessary (i.e., covered by insurance) even though exercise bike is part of recovery therapy - because he has never prescribed one before.  So I just got back from the bike store where I put down my own $$ for a recumbent exercise bike, including crank arms where you can adjust how far out the pedals are.  Pedaling one footed is going to be hard, I discoveredand a shorter arm should make that easier.  I would go nuts without some sort of regular exercise.  I have been practicing a little with my old crutches to make sure I have the balance, and I want to start using the one legged bike routine before surgery. 

I also read where people complained about not being able to carry things.  I was going to have a friend make me a little cart I could tow, but it occurred to me that a wheelchair with a table was a better choice.  A wheelchair should also make it easier to access things in the fridge, stove, etc, because I will have two hands free.  And it would let me take a "walk" in the winter.  Even when the walks are all shoveled there are still slippery spots.  Sound familiar?  The Dr.'s assistant told me I wouldn't need that because I could be dropped off underneath the overhang when I went for Dr. or PT visits.  She didn't get the concept that I want to be outside recreationally somehow!  And amazingly a friend called today to ask if I wanted to borrow the wheelchair her father used before he died.

Like I said, I am so pleased to have runinto your blog.  It's nice being able to get this stuff all organized well before surgery, and get a little no risk practice before doing it for real.

Thanks for the encouragement.  And never say die, is my motto.  I have twwin friends who are 73, ski aeverything at Sun Valley (on an all season pass, they liive there allwinter) , bike the big mountains in Europe and play a mean game of singles tennis.  Inspiration.  So I may be 58, but I figure I have to make plans for at least 15 or 20 years of being active.

Thanks again.  Appreciate any more thoughts.  Not to mention encouragement. 

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on November 17, 2010, 02:09:56 AM
DFO - pre-op.  Since I live alone, I will have no one to tell "feed me grapes, b***h".  And recuperation will be during a Wisconsin winter.  So, I'm going to try to describe the little things I've been trying to figure out how to do, both for comment and for those who may follow idown the path I have chosen.  Some on the site have suggested that they felt that a recumbent exercise bike would be safer, so I bought one.  Glad I bought it well in advance.  Biking with one leg is my intended aerobic exercise for a while, and it's trickier to master than I thought.  I plan to live mostly on the first floor and sponge bathe, but I know I will need a shower from time to time, and that's on the second floor.  I've used crutches twice before, and at my old house the handrail was sturdy. I just put both crutches under one arm (the one above the injured leg) and used the rail for the second dupport, so I could walk up.  The handrails at this house don't feel like they will bear that much weight, especially for months.  I tried crawling up the stairs on my butt, dragging the crutches, but that was awkward.  So I dug out my second pair of crutches and intend to leave one pair upstairs, one pair down.  Much easier to "butt" my way up and down the stairs if I don't have to haul the crutches (did I mention that I have given up all hope of dignity?  even the cats seem confused).  It took a while to figure out how to get into the shower, and I think I've got it, but it involves a couple moves I learned when I was still rock climbing.  It will take courage to take a shower, and I'm afraid that by the time I get dressed and back down the stairs. I will need another shower.  Oh, and I borrowed a wheel chair.  I don't like the idea of walking with crutches on ice and snow, and I will need to get outside from time to time; the wheel chair and a friend to prevent disaster should allow me to do that.  And if it fits through the right doors, a wheelchair may give me a way to carry things, at least on the first floor of the house. 

I am counting on friends to help me with getting to appointments (I have two retired friends who live less than 1/2 mile away), and for getting and preparing food.  One woman even volunteered to coordinate who was coming when.  I had hired the neighbor kid to shovel my snow, but at the advice of a friend, his duties have now been expanded to cleaning the litter boxes and feeding the cats.  He does this when I'm out of town anyway.  And I've hired a cleaning service, and they even agreed to do the laundry.  This is all more expensive than I had planned, but the basic advice I got was, don't ask your friends to do unpleasant thikings and they will be more likely to actuallly come.  I probably won't be spending much money going out on the town, so maybe it will all work out.

I now have what may seem like silly questions, but I would really appreciate some input.  How much flexion should one expect in the knee post surgery?  Put bluntly, I'm not all that flexible, and I'm a little puzzled as to how one puts on and takes off things like shoes, socks and pants.    Anyone have any input on this?

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on December 22, 2010, 12:56:02 AM
Don't know if anyone is reading this any more, but I have a couple thoughts to share. Had distal femur osteptomy on my right leg on Decmeber 9.  People at hospital were wonderful, the food was even good.  Surgery went exactly as planned.

Doctor wanted me to walk flat foot with 50 to 75 pounds on the operated upon leg right from the start.  That actuallly made getting things done around th house easier, as I could stnd on both feet without crutches and just lean hard to the left.  Always stayed in a left hand corner with something like the edge of the counterrtop to grab, but being flatfooted on both feet made balance pretty solid.  I have a number of friends who have been very helpful, two particularly so.  Nancy brought me bags of ice every morning, and Leslie has been cating me around.  I'm doing PT ath the hospital and they have a courtesy van. 

Just got back from first doctor visit.  too early to see bone growth 12 days post surgery, but on the other hand everything is as it should be at this stage.  He increased the range of motion on the brace from 30 degrees to 60, much easier to get into a car.  Doctor told me that it would normally be 6 to 8 post surgery before I lost the crutches and brace.  After reading this blog I'm counting on 10 and anything less will be a plus.

Mainly the purpose of this messageis to thank everyone again for their reports, so I went into this having some idea what to expect.  This is an operation you have to approach with a zen like attitude.  Knowing roughly what to expect has made it easier for me to be patient and it feels like the first two weeks have actually gone pretty quickly.  The trick now is to maintain that attitude.

thanks again
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: kman on December 22, 2010, 09:42:53 AM
Dear Aturpin,

I felt obligated to thank you for your postings.  I had a DFO on December 8th, 2010 (Exactly 2 years minus a day after yours).  In my recovery, I have been reading through your posts and getting a feel for what to expect as time passes.  I am 36 years old, very active in my lifestyle and was in a motorcycle accident about 5 1/2 years ago that led to this surgery now.  I started with a knee scope that revealed almost no cartilage left and a very damaged meniscus.  The Doc did a "Micro-Fracture" immediately and cleaned up the meniscus.  The MF is drilling a bunch of tiny holes in the top of the Tibia to promote scar tissue growth in exchange for cartilage.  This won't last more than 5 - 10 years, but I didn't have a choice; mine was gone.  The only option was the DFO now.

So, I couldn't walk on my leg for 8 weeks prior to the DFO because of the micro-fracture healing and now have been on crutches another 2 weeks since my DFO :-)  Needless to say, I get around like a pro on them. 

I am pretty healthy and a non-smoker (never smoked), so I expect the bone to grow back rapidly and completely as any other bone breaks I've had did as well.  I won't give you the details of my motorcycle accident, but I healed fast :-)

I have to say, my heart goes out to you and your dedication to helping others in your experiences with your surgery.  I almost cried when I got to page 16 and noticed that after almost 2 years you had still posted!  Iím glad to know you are doing well and I expect to work very hard to get results as fast as I possibly can.  My biggest hurdle is that I am now single and Iím bored out of my mind!  :-)  I like getting out and there are just so much you can do resting indoors in a bed.  Not to mention, I live in Michigan where there is now SNOW on the ground outside Ė lol  Living in Southern Cali, Iím sure that never crossed your mind :-)
Again, thank you for your thoughts for the past two years.  Your notes and thoughtfulness will add in my speedy recovery. 

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on January 22, 2011, 01:29:40 PM
Dear Aturpin

You probably have better things to do by now than to read this blog, but in case you are, I would like to quote to you from your post of Nov 8 "While I have always heard, and my doctor has reitterated, it is best to keep the original parts as long as possible, surgery at 58 can be more difficult to recover from."† I have been a little reluctant to post until I had some solid evidence, but here is my current status report re my 12/09/10 DFP

Based what was happening in PT, I was able to was able (with safety of a hand rail on one side and a crutch held on the other, each increasingly loosely held), from the fourth week after surgery to the fifth, I was able to transition to walking Ė over obstacles, and up and down a single stair Ė totally on my own power.† The next week brought walking all over the PT room, pulling against a rubber hose held by the PT, using just a non-weight bearing crane.†

The next week I stopped using the brace and crutches at home, even the cane for brief walks.†

For the first 4 weeks after surgery, I was using a recumbent bike powered only by the non-operated left leg, getting up to 90 minutes.† In weeks 4 and 5, I did exercise bike with two legs. Quickly going up to 60 to 90 minutes, and transitioning from recumbent exercise bike to regular bike on wind trainer.† I could easily clip in and out of the pedals.†

I made an appointment† with the surgeon for yesterday, 6 weeks and a day after surgery.† The doctor came in before any x ray had been taken.† He said I had come in too soon for an x ray to be relevant.† I told him that based on what was going on in PT and in the rest of my life we needed an x-ray.† He said ok, and 10 minutes later he was back in the room x ray on the wall, admitting I was right.† The bone was completely healed and I no longer needed the brace (except if there was snow or ice), crutches or any further x rays.† It had probably completely healed in 5 weeks, maybe even a little earlier.† I lost almost no leg strength.† Still need work on range of motion.

I have a good surgeon, I worked hard (and I am probably a bad person for posting this).† Still lots of work to go.† Up stairs foot over foot is a piece of cake, but down...

Thanks again for your diary. It has been of immense help.† I keep going back to it.† In the next few days I will try to post some advice for people doing this totally on their own, expecially in wisconsin in the winter.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 10, 2011, 11:13:52 PM
I realize it has been a ridiculous length of time since my last update so my apologies. I'll keep it brief since all in all , I have no changes to report. This is a good thing because it means I continue to be better post-op than I was pre osteotomy.  Even though I swore I wouldn't, I have done some very limited running with pretty good success. The more I do it, the more comfortable I get.  I keep my runs to a mile or under (just enough to scratch the itch) and I feel little discomfort during or after.  While the subject leg lacks the responsiveness it once had, I am really pleased that I have been able to return to pretty much everything I want to do. I recently summitted Half Dome in Yosemite, have been playing tennis (singles, not competitive but hitting off one bounce usu.) and do some jogging, I cant ask for much more than that.  All post op MRIs show that the cartilage degeneration I had pre-op has not progressed since my surgery which was the entire point of all this. Mission accomplished.

Hope you all are doing well out there. Don't despair, there is light at the end of the osteotomy post op tunnel .  :)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on August 11, 2011, 12:14:31 AM

Thanks for the update and glad you are doing well.  I had my DFO on 12/9/10 and have checked back to this post from time to time during my recuperation to see how you were doing at the same stage. 

Since my last post in late January, progress has continued to be fairly rapid, although slowed down a bit by the ice and snow.  February consisted of walking and exercise bike, eventually getting both up to 2 hours with both.  Considering both were indoors it was a bit boring.  By mid February I was shovelling my own snow, sometimes over 12 inches at a time.  I'm sure the doctor wouldn't have approved. 

In late February I had another doctor appointment.  At that point he told me that the bone had healed so well he couldn't tell if it had been 3 months or 3 years since the surgery and that there was no reason for further x-rays.  Even the scar had virtually disappeared.  He made me promise to wait until at least April until I biked outside, but I started on March 3 with a 15 mile bike ride in the snow.  By mid March, when we had a nice day (by our standards here in Milwaukee) I did a 50 mile ride.  That one ached a bit by the end, but no problem after I got home.

By the beginning of April, four months post surgery, I could no longer really tell I'd had the operation, save two things.  The operation site ached if I biked hard, the doctor saying it was normal and that I needed to form a bursa next to the TI plate so the IT band and muscle could move more smoothly over the plate.  And, strangely, I couldn't sit in a chair with my leg at a 90 degree angle (think movie theater) for more than 20 minutes or I would ache so much I would have to get up and leave.  Other than that life was almost perfectly normal, walking stairs, whatever I wanted to do. I was remodelling the basement carrying 50 pound boxes of tiles down a flight of stairs.

It has taken a while to get some speed up on the bike because I didn't want the leg to ache too severely.  I did do a hilly century in June, about 7 months post surgery, with no trouble.   

It is now 9 months post surgery.  I got mugged on the bike path last week, punched in the face.  It didn't knock me over, and I sprinted to safety at 28 about miles per hour.  Pretty lucky, but it showed that the strength was there, at least if the adrenaline was flowing hard enough.   :)  The ache I was experiencing when biking hard is only barely noticeable and no hindrance at all.

I wasn't able to run pre surgery, but the doctor indicated I would be able to do so post surgery, very moderately.  I haven't run more than a few hundred yards, and calling it "running" exaggerates substantially.  I have another appointment with the doctor on Friday and we'll chat about what makes sense. 

Bottom line is that I'm almost exactly back to where I was pre-surgery except the knee doesn't hurt, and I tend not to push quite as hard, not because I can't, but because I want my real knee to last as long as possible.   

So I want to second your notion that there is there is light at the end of the osteotomy post op tunnel.  Hope you are all doing well out there, and it would be interesting to see how things turned out for other people.  And thaks again to Aturpin for starting this blog.  I t has been most helpful.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 29, 2011, 08:54:55 PM
Wow Tomas!  I am very impressed at all you can do and how quickly you got there.  I have to say that at 9 months, I was nowhere near a century or carrying tiles up and down steps. I think that is interesting though.  For those out there who are comparing progress and timelines, progress is progress.  I suppose its just like life, if that isnt too profound for a knee blog, in that we may not be the first to read, the first to walk, the first to get a job, etc. but ultimately most all of us will get there if you keep trying and keep working at it.  Its great to hear from another success story and all that we have gone through just to be where we are.  I am with you: be as gentle as possible while still balancing the desire to get out and play because I want this knee to last as long as possible... the fewer of these things I have to go through, the better!  Congrats again, so glad you are doing so well.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on September 14, 2012, 08:46:28 PM
September 14, 2012.  21 months after DFO.  Just got back from 16 days of bicyling from Vienna to Venice.  About 800 miles, well over 100,000 feet of climbing, frequently 15% grade or above.  I'm not as fast as I used to be, but then again I'm 60 years old.  The important part is the only time during the trip that my DFO made any difference was going through the TSA security.  I had to push hard to get over the passes in the Alps and Dolomites, but no pain in the knee or leg.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on November 12, 2012, 10:27:00 PM
Hi Tomas and all of the knee afflicted out there!

I must have sensed a disturbance or something because it had been months (ok, maybe a year) since I had even thought about the knee geek "blog" I had once dedicated so much time to and then out of the blue I thought, "I owe a post, its been a while".  Turns out just a couple of months ago you gave us an update on your knee and your big trip.  I am so  jealous about the trip, it sounds like a dream.  I did a mini tour myself this past year.  Well, for me it was a big deal but compared to Tomas' it was mini.  I road from San Francisco to Huntington Beach, Ca - about 500 miles with some good climbs through Big Sur but not near 100,000 ft. It was one of the best trips I've ever taken and I was so happy my knee was solid enough to do it. No knee pain, only saddle pain :).

Things continue to go well with my knee.  No news to report really and no news is good news.  I am having and MRI every two years to track the cartilage on my lateral condyle.  If it degenerates too badly I am on my way to another surgery, probably OAT.  That MRI will take place near the turn of the year and Ill be sure to report back as the entire objective of the DFO procedure was to prevent further deterioration of the remaining cartilage/defect. So far so good.  Keep on keepin' on!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on May 31, 2013, 06:20:17 PM
Dear Aturpin,  I do not know who you are young lady - but I want you to know just how much I appreciate the day to day blog that you posted on this site.  I am a 59 year old female that just learned this week that I will have to have my right femur straightened before I can have my knee replaced.  I injured the knee 40 years ago and in those days they did not repair the cartlidges - they removed them.  Through the years my knee has become knock-kneed and although it does not give me any pain - my right ankle is killing me - which is what sent me to the doctor.  Up until now I had refused to let them touch my knee and now I will pay the price.  I don't mind telling you that I am scared to death!!!  I have had 2 surgeries on this knee and they were both very painful. 
I hope your progress is all you hoped it would be and more.  Thank you from the bottom of my heart - I am not so scared any more.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Tomas52 on May 31, 2013, 09:24:38 PM
Dear Lee Tipton

I had 2 surgeries on my knee before having a DFO, one in which the doctor operated on the medial side of the knee instead of the lateral (and said "oops" when I told him he was on the wrong side). I had no meniscus on the lateral side of my knee, and the chondile had worn flat from being so knock kneed.

I had the DFO at age 58.  I think I had a very fortunate and quick recovery.  But there is no reason to be scared.  Aturpin told me I was too old to have a DFO.  I don't think it's a matter of age at all.  I think it's a matter of attitude and having someone around to help you with the little stuff (I was living alone when I had the surgery, but fortunately friends helped out).

I am not going to tell you that it's fun, but I kept the leg connstantly iced (with one of those coolers with a pump and hoses that lead to a pad at the surgical sight), and I experienced almost no post operative pain.  Get a good doctor.  My doctor used a then new compound (I forget the name) which sped  my healing.  Almost 2 1/2 years out and absolutely no complaints. 

I don't envy you a DFO, then a knee replacement, but you will do fine.  Make sure you get good PT, and make sure you do some work at home between sessions to the extent you can
It's up to people like us to show these youngsters a thing or two.  ;-)  You will be getting around normally before you know it.  Hang in there.

PS  I owe a huge debt of gratitude to Aturpin for alll the practical advice, and mostly for letting me know what to expect and how to deal with it.   

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: christine67 on June 01, 2013, 11:49:39 AM
Hi Lee Tipton

I was in the same situation as you having to have a DFO before my Partial knee replacement which I had last year I had a few complication's with my bone not healing as my OS did it the nail version at first so ended up having bone graft which failed and then the metal work taken out and fixed with a plate which did the trick it was a long and stressful time but I think I was just unlucky but on the positive side I am recovering well now.

I am now waiting for my PFJR & TTT which will hopefully be in the next couple of months.

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on June 17, 2013, 08:01:00 PM
Hello Christine!!! 

Thank you so much for replying to my post.  It is nice to know that I am not alone out here.  You have had more than your share of issues I see.  But you seem to be weathering the storms and maybe things will only get better from here on out for you.  I will add your name to my prayer list. 

I will be going for my 2nd opinion on the 25th as I have been told by 2 people that care about me that I need to get a 2nd opinion.  They are good aquaintances to me - but not real close friends, but one of them is an RN - so - I am taking their advice and getting a 2nd opinion.  I am pretty sure that I am headed for an operation though. 

Again - thanks for the input and best wishes to you.
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on June 18, 2013, 09:25:30 PM
Hello Tomas,

and thank you for your insight!!  I know I am 59 - but I don't necessarily let it affect me much.  I don't do any "Euro" bike riding - you lucky thing!! - but I do ride my bike out at Lodi Lake - and I get to see the family of deer that eat back on the trails.  It is a 10 mile ride there, around the trails and back - so I am doing stuff.  I had to get myself an Electra Townie bike - because the pedals are set forward - but I love to ride my bike.

I am going for my 2nd opinion on next Tuesday - just to make sure this is really necessary - then I am going to start scheduling the big event.  I am very apprehensive - ok - so I am scared out of my wits!!!  I don't know if I am as scared of this as I am of the knee replacement - but I am worred - to be sure. 

Take care, be well,
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: nalomelli on July 14, 2013, 03:20:54 PM
Hi all!

First I greatly appreciate all the wonderful insight on this thread. I'm not sure how many people still reply to the thread, but I need some advice.

I am 26, female. When I was 15, I tore my lateral meniscus in my right knee and had arthroscopic surgery. I played lots of soccer - (including NCAA soccer) and ran much over the years.  I recently went to the knee doctor because my knee swelled up considerably after a soccer game, after being kneed in the quadricep. What I expected to be "ice and rest" advice turned into much much more.  After getting an MRI, I was told that my lateral meniscus is no longer functioning (squeezed off to the side of my knee). I also have osteoarthritis and damaged cartilage in that area of my knee.  X-rays of my alignment show I am putting weight on the outer side of my knee in the damaged area.

My doctor (in Austin, TX) recommended a DFO to correct the alignment and slow the cartilage damage and progression of arthritis. He told me my soccer days and running are over, even after I get the surgery. I got a second opinion at UCSF (in San Francisco, CA) near my home town, and the doctor there agreed with my original doctor's recommendation.

Here's my dilemma. Right now I've switched to low impact activities (swimming, biking, yoga, etc.) and I do not really have any day-to-day pain in my knee. Even before my diagnosis, my knee was only sore after a long run. The way the doctors talk about my knee and my arthritis, I feel I should be in much more pain.

Although I know the surgery is important to lengthen the life of my knee, it is hard for me to go forward with the surgery when I have very minimal pain. Sometimes I am skeptical of a surgeon's advice - as surgery is the only answer. At the same time, I know I should preserve what cartilage I have left.

Thanks for reading.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on July 19, 2013, 05:42:48 PM
I am so sorry that I have not seen your post until right now.  I have been too busy and neglected to check out this site - my apologies.

I am curious as to what you have decided/done about your knee.  As young as you are - I will say this to you.  I waited far too long to get my knee even looked at.  I waited 40 years to have some serious xrays/scans done of this knee.  I raised 3 kids and buried the love of my life in those days - so it was not all my fault - but I am left to deal with this alone. 

What I am saying to you is that do it now or do it later - you will be doing this.  I had a total right medial menisectomy at 19 years of age - they did not repair meniscus in those days - they removed meniscus.  So 40 years later my entire knee has broken down and my femur has taken a sharp left turn.  But I have no pain in the knee at all - but my ankle is now involved and is extremely painful.  Be careful - some pain radiates and that may be what is happening to you.

I am scared out of my wits - but I guess I have no choice.  If I do not do this now - I may not have the opportunity to do it later.  I have had 2 doctors tell me that I will need a total knee replacement.  One said he would do it without straightening the femur - but the other one will not.  I am very torn.  But I am going to the doctor today - so it is decision time.

Best of luck to you.
Lee Tipton

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 28, 2013, 06:22:57 PM
Hi nalomelli,

I am sorry to read of your knee misfortune and also sorry that two weeks have passed since you posted. Considering how infrequently I check back here, it's sort of serendipitous that its only been two weeks but by now you may have made a decision and are on a set course. If not, I would submit the following for consideration:

my OS keeps saying that if my pain is under control and my quality of life is good, surgery will not improve upon that. It sounds like you are fairly pain free most days. The only other consideration, as you say, is preserving the cartilage. This is really the entire objective for a DFO. That's why I decided to go forward with the procedure and I am glad I did. Staying with low impact activities also goes a long way in preserving cartilage. Also, it is likely that if you don't have the DFO now, a doctor down the line will recommend it before doing other cartilage related procedures. For instance, my next step is an osteoallograft transplant which my doctor wouldn't do if I hadn't had the DFO.

It's a tough decision. You will just have to make the best decision for you. I would also encourage third, fourth, fifth opinions. Good luck and don't hesitate to reach out with questions should you go down the DFO path.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 28, 2013, 06:33:26 PM
I also feel compelled to add that I never said 58 was too old to have an osteotomy. In an earlier response to a post I reiterated what my doctor had told me and what I believe is a widely accepted fact which is, generally speaking, we don't recover as quickly as we age. I was advised to take this into account when I was considering whether or not to do this procedure now or later and wanted to pass that advice along.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on July 28, 2013, 06:54:37 PM
Hi Lee Tipton,

I'm so glad you are getting a second opinion, more is more when it comes to information. Try not to be scared, if you have had 3 kids and raised them, this is a piece of cake! I'm so happy that my experience has helped you, that's all I set out to do. Good luck to you, work hard through rehab, and stay positive.

Warm regards,
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: clsknee on July 30, 2013, 09:16:22 PM
Hi Aturpin!

Thank you so very much for sharing your experience :)  Your story is one of the first I read as I was researching the next proposed procedure (DFO) that doc has recommended.  I am 30, female & also used to run college track Division I!  (however I was not A team, lol)... I only got through one indoor & outdoor season though as my knee was not doing so well...

I have some questions for you though!  (not sure if this is the right place on site to ask them; I'm new here)  First, quick back story: My right knee cap started dislocating when I was 14 (mostly always happened while playing basketball).  I had a lateral release scope at 14, a VMO advancement at 14, then a TTT at 15 plus screw removal.  At 22, I had my knee cleaned out in another scope (at which point Doc said "no more running"), and I just had another exploratory scope here at a military hospital as I'm now married to a wonderful man in the Air Force.  I'm having some troubles with it locking & catching now post-op, but hopefully if this all clears up soon, I'll have a distal femoral varus osteotomy in the fall sometime.  Just like you, I have a 12 degree valgus deformity in my right knee (the one to be operated on), but I was also surprised to find out yesterday that I'm also about 10 degrees valgus in my left knee.   

The doctor here said that he would also want to do a cartilage implant at the same time.  During my scope last month, he took a biopsy of cartilage to grow for this.  I have osteoarthritis really bad already in my lateral side (level 4, worn-out) with about a 2 cm lesion of bone sticking out.  I'm about a level 3 osteoarthritis everywhere else in right knee.  I had to give up running 8 years ago, and as the years have gone by, I've had to give up pretty much every activity except for walking and swimming.  We hope to have children soon, so I'm wanting to fight for my health and to be a mobile Mommy someday!

How are you doing with your recovery?  Yours was about 5 years ago?  Have you had great results & what's your activity level now?  Did you end up having the cartilage implant (ACI)?  We're in California, too; I remember you mentioned your Dr. is in San Diego?  He is a specialist in DFOs?  I really like my Dr. here on base, but he hasn't performed many of this particular surgery.  Any updates or information you can share would be spectacular!  Thanks again for documenting your experience for us all to see & learn from :D

Warm regards,


Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: clsknee on July 30, 2013, 09:32:15 PM
Anyone else's feedback & comments would be amazing & greatly appreciated, too!   ;)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: aturpin on August 24, 2013, 12:57:31 AM
Hi Clsknee,

Very nice to here from you, we have so much in common!  It sounds like you are my knee twin although I think you have endured more than I have.

If Im not mistaken I think you are describing ACI with DFO for your next trick :).   I have looked into ACI and OAT for my options but have not done anything with the cartilage yet.  Fortunately, the DFO has enabled me to avoid it for now.  Right around the time I was doing the DFO I also inquired about doing the cartilage surgery and DFO at the same time (one surgery, one recovery).  Many people on these boards have done it that way. My Dr.  recommended against it. His point of view was that two big procedures might compromise the healing - too much for the body to repair successfully.  In hindsight, I am glad I didnt do it because I am able to get a few more years out of the cartilage I have.  Everyone is different though and your arthritis is more advanced than I - you may not have more years of cartilage.

Anyway, to answer your questions:

Yes, about 5 years ago - time flies!!!! I really believe my results have been great and I consider myself very active. However, I cant do everything.  Like you, I really dont run much.  I dabble because I miss it but get pain during and after any run over 1 mile. I also tried to play singles tennis every week and that did not go so well.  Nor did a 10 week season of softball - the sprinting/base running really turned out to be cumulative and by the end I was pretty sore. I do a ton of bike riding, hiking, yoga, swimming, weightlifting, and general gym stuff (elliptical, stairmaster, limited treadmill running).  I have also done some sprint triathlons either walking the run or running the run without training for it.

I have not done the cartilage transplant yet but my doctor recommended the OAT procedure over ACI. I have a friend who did ACI and he seems happy with it.  The only drawback for him was that the cartilage continued to grow after the transplant requiring a followup surgery to remove the excess.  Imagine that TOO MUCH cartilage!  ACI also requires two operations - one of which you have already done - which was the primary reason my doctor gave to go with OAT.  I will likely reconsider everything once I am ready to do cartilage surgery. I am hoping they continue to make progress while I wait on the sideline.

My Dr is Dr. William Bugbee out of Scripps Clinic and he does specialize in DFOs and cartilage. I am glad you like your doctor but I would really encourage you to consider using someone who has done this before.  You get one right knee. Good luck!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: LHall on August 24, 2013, 05:00:54 PM
I, too, would like to thank aturpin for your pre- and post-op diary. I was pleasantly surprised today when I went back to look at some of your older posts and found that you had posted recently. Your diary has been a life saver for me over the past 8 months! I can't tell you how many times I've returned to your posts for advice, encouragement, and consolation.

I had never heard of a distal femoral osteotomy when I went to see a dr. in Lexington, KY (Univ of KY) who said he might could help me. I had been "written off" by several dr.s in my hometown (Knoxville, TN). I tore my meniscus in March 2012. I had my first scope on the left knee in May 2012. The meniscus was frayed, so my dr., knowing I was a runner, personal trainer, and group exercise instructor, cut out the meniscus, leaving me with bone-on-bone grade IV arthritis. I was in more pain following the surgery than before. I had a 2nd scope in August 2012 by his partner who "specialized" in knees, which resulted in a lateral release, cleaning up loose fragments, and trimming more of the meniscus. I did fairly well following that scope until I jumped when teaching a class one day. After that, the pain became unbearable, but I was told there was nothing left to be done except to live with the pain--I was also told my days of running, teaching, training were over. I got a 3rd opinion & was told the same thing, plus that I was too young for a knee replacement (I'm 53). Of course after that I was angry and extremely depressed at the same time. I then set out on a journey for a doctor who WOULD help me. I would not take NO for an answer!

After searching the internet and sending my records to numerous doctors and clinics around the U.S., I was given the name of a dr at Vanderbilt Hospital who might could help me. I left his office with a Rx for glucosamine--seriously? I was way past glucosamine! However, he gave me the name of a dr in Lexington to get yet another opinion. After sending this dr. my records he was hesitant to offer anything (like hope??) to me, but wanted to see me regardless. After doing long leg x-rays, he determined a DFO would give me 5-10 years of doing the things I love before I would need a knee replacement. After praying about it for a few days, I knew I HAD to try this option. I had the first (yes, first!) DFO on Jan. 30, 2013.

The surgery went well & I was allowed to weight bear rather quickly--off of crutches within 4 weeks. I was then allowed to ride the stationary bike and in April, to get on the elliptical. In April I began to have quite a bit of pain when walking. My surgeon attributed this pain to the IT band, which I could feel "snapping" over the plate. By mid-May, however, I couldn't put any weight on the leg & was back on crutches. I contacted my OS & begged him to either take out the plate or to put a smaller plate in. He finally agreed to replace it with a smaller plate. Before surgery, I had a CT scan which revealed non-union. During the 2nd surgery, on June 5, he discovered 5 of the titanium pins were completely broken at the screw heads. intense pain was from the bone moving at the osteotomy site (it never healed & had turned to soft tissue); the plate began to loosen and move because of the movement in the bone. I actually felt a "pop" one day at the gym & I think this was probably the final screw(s) breaking!

Needless to say, my OS was very upset, as he had never before seen or heard of this happening with this particular heavy-duty plate. He uses this plate whether his patient weighs 300lbs or 100lbs (I'm about 125lbs). I was on crutches for 8 weeks following the 2nd DFO, completely non-weight bearing. Over the past few weeks I've been able to gradually wean off the crutches & now am completely weight bearing WITHOUT pain!

It feels so amazing to be pain free after 1 1/2 years of sometimes unbearable pain. People do not understand chronic pain unless they have experienced it themselves. As many or most of you know, it consumes every thought, every day, all day. And night. To finally be pain-free is amazing! Although I'm not out of the woods yet, I do have a bone stimulator that has sped up the healing of the femur & there is more new bone growth now than we ever saw in the 4 months following the first DFO. Although my diet is still lacking--I have a huge (almost ridiculous) fear of becoming overweight from being inactive for so long--I'm taking quite a few supplements & am very conscious of how much protein I eat daily. I think I'm finally on the road towards complete healing & towards getting back to doing the things I love the most!

It feels so great to share this with people who understand what it's like to have a lifestyle you love (& that is healthy!) to be taken away from you. I think we are fighters & will do what it takes to get back to where we were & to what we love. I shared my story not to discourage anyone from having this procedure or to scare anyone, but to tell others that it is a journey, there will probably be some set-backs, and it's not an easy  journey. But from previous posts, I believe it's a journey worth taking if you want an active lifestyle, no matter what your age is! If you're not finding the answers you want, keep searching. I went through literally about 8 or 9 doctors before anyone even mentioned a DFO, much less offered it as a solution!

Sorry this post is soooo long! But if I help one person make a decision or get through a tough day--well, then it's worth every word typed and every obstacle I've faced. Stay strong & don't take "NO" for an answer!
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: clsknee on September 03, 2013, 01:50:52 AM
Thank you so very much Aturpin, for your reply!!!  It is much appreciated & very valued :) 

I was wondering... Has anyone heard of or tried the new, innovative Platelet-Rich Plasma therapy (PRP) to treat your osteoarthritis?  I have grade III & grade IV OA in my right knee, so I am considering it... it sounds very promising!  After 6 knee surgeries, I'm just not sure that I want to jump right into another one.  I'm 30 and will probably need a knee replacement by 40, so I'm looking for more non-invasive options as possibilities for now.  Physical therapy is going great though & really helping to wake back up all those old muscle/tendon/nerve connections! 


~ Clsknee
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on September 13, 2013, 11:58:03 PM
Hello Everyone, 

I have been reading the updates and I suppose that I consider myself very fortunate.  I do not have too much pain at all in my injured right knee - but my ankle is very painful.  My DFO is scheduled for 11/5/13 and I am scared - very scared.  I come in here to ready Auturpin's posts because they give me much hope.

I will pray for us all - this is a tough life we live. 
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: LHall on September 16, 2013, 02:52:06 PM
clsknee, I saw my dr. last week and asked him about PRP injections. He told me that there was not enough evidence through research that these injections really help with cartilage growth or with pain. He feels that it's hyped up to offer more than it actually does. He was/is willing to do the procedure, but cautioned me that insurance does not pay for this and it would cost anywhere from $300-$900 a treatment. I trust this dr.'s opinion greatly since he does quite a bit of research studies himself. For me, at this point in my recovery, it's not worth spending even more $$ without solid proof that it works. However, you're quite a bit younger than me, and it might be worth trying to buy you some more time before another surgery. I've had 4 surgeries on my knee so I know how you feel about not wanting yet another surgery.

Lee, even though your knee isn't painful, your ankle is. Pain is pain, and it interferes with everything we do--every step, almost every thought. I will be praying for your upcoming surgery--for courage, hope, and healing! Remember that it is a journey, sometimes a really long one, but I do believe that the outcome--living pain free & getting your life back--is totally worth every step. Hopefully you'll be healed & ready to go by the time spring arrives! Please keep us posted!

As for myself, I had a CT scan last week & it shows LOTS of new bone growth and healing! I was anxious and scared to death when I went in to see my dr., having had the first surgery result in non-union, but I left his office on cloud 9! I have very little pain and am gradually increasing my activity--I'm now walking 1 mile a day, on the stationary bike with some resistance, and on the elliptical. I've started back teaching one group fitness class (a non-impact class that involves weight lifting) and can even do squats and lunges (bodyweight only)! He told me I could work out no more than 1 1/2 hours a day, which is great with me. I go back in 8 weeks and he told me he might let me start doing a little running at that point! I'm still using the bone stimulator every single day and I believe it's a huge factor in the healing that we're seeing. I feel like, after 1 1/2 years, I am closer to getting my life back than ever!

I pray that everyone who undergoes this procedure will have great results and will lead you back to the lifestyle that you love. Hang in there!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: northmonkey49 on October 07, 2013, 09:58:12 PM
Hi All, hopefully someone can advise:

I had a distal femoral osteotomy 76 days ago (11weeks) and I seem to be making good progress. Whilst my ROM is now 100degrees +, I am experiencing severe pain on flexion. The pain can be pinpointed to a small lump at the foot of my scar (about an inch  from the midpoint of my patella on the medial side). It's agony to press on and a sharp pain when I try and bend my leg.

Trying to cycle is the worst, I have the seat a lot a higher and am struggling still to perform one rotation without severe pain. Has anyone else had these problems? Is this scar tissue? Can this be a screw? Or is part of the healing process?

Overall, I am walking reasonably well (came off the crutches after 9 weeks although I was able to walk after 6-7 weeks). And I'm building things up nicely in the gym, I am just fighting this horrific pain. I am not back at work yet (I teach physical ed).

The surgeon seemed pleased with my x ray at 9 weeks. I am still icing a number of times a day and I'm still taking quite strong pain relief. He didn't seem bothered by the lump, initially my PT thought it may have been a burst heamotoma, but the lump is solid. It seems to have got ton worse in the past two weeks although the lump hasn't changed in size (small egg shape).

My leg feels strong, much straighter and definitely alleviated the pain on the lateral side. I just cannot understand why I am getting such localised and sharp pain at the base of my scar. If anyone has any words of wisdom then I would very much value your input.

Thanks in anticipation

33yr old female
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on October 11, 2013, 10:50:33 PM
Dear Aturpin,

I am 3 weeks and a few days away from this surgery.  My surgery will be on my right leg however and I have been told by my 2nd opinion doctor that my curve is more than 15%. 

Whatever comes my way - I have no choice but to do this.  My foot and ankle is so painful that I cannot live like this.

Also I want to tell you how much I appreciate the diary you did.  I am on my second trip through it and I am not having nightmares about all of this.  So thank you again.

I am going to try to do a diary myself and I see that you used the reply facility so I will try that as well.

I know you are continuing to do well - but I never see Cherub.  I hope she got alright.

thanks and warmest regards,
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: LHall on October 13, 2013, 05:06:07 PM
The pain you're describing is very much like the pain I experienced about 3 months out of my first DFO. The pain began when I was using the stationary bike and elliptical. It progressed to the point where weight bearing became unbelievably painful. Within this time frame, I saw my doctor at least twice. X-rays revealed healing & that the plate was in place. The pain was attributed to tendonitis in the IT band. As I got closer to the 4 month post-op date, I was back on crutches and begging my dr. to remove the plate. He agreed to replace it with a smaller plate & to reposition it. However, when he performed the surgery he was VERY surprised to find 5 of the titanium screws completely broken and that the bone had not healed, even though like I said, previous x-rays suggested that everything was moving along nicely. Apparently, since the osteotomy had not healed, the bone was moving, causing the plate to loosen & eventually sheer the screw heads into.

All that being said, you most definitely need to be insistent with your dr. to take your pain seriously and to find out why you are having such severe pain. It could be something as simple as scar tissue or something as serious as what I experienced. I don't mean to scare you, but unbearable pain is NOT normal!

I hope this helps you a little. It's so miserable to live in pain like you are. Chronic pain consumes the mind and slowly wears away your quality of life. I hope you find an answer very soon!

Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: clsknee on October 21, 2013, 01:45:18 PM
Lisa, thank you so very much for your input on the PRP & for asking your dr.  Even though my doc who did my first 5 surgeries recommend it, my current doc here on base basically said the same thing as your surgeon.  So that gives me a peace about not trying it at this point.  I'm glad to hear you're doing better! 

Lee, I'll definitely be praying for you & that all goes smooth with your upcoming surgery!  I pray that your surgeon & all the medical staff get lots of good quality sleep the night before, too:-). You're going to do great!  Just keep a victory & restoration mind set!  I believe you're on your way to so much healing & relief & increased mobility!!!  Getting back to doing the physical activities you enjoy & leading an active lifestyle!  I'm so excited for you & what a courageous journey you're embarking on!!!

My husband & I have been prayerfully considering this next surgery (it will be a DFO, cartilage resurfacing -AIT?, plus the removal of a GIANT bone spur on the lateral side)... This would be knee surgery number 7 for me, all on my right knee.  In my flesh in the physical realm my body says NOOOO, not again!  Lol, but we are much more than just physical beings & deep down, I feel this is my best option for fighting for an active lifestyle & my future health!  God has opened many doors for this to be a great season of life to get this done & to move forward!  My hubby & I are looking forward to starting to try for children soon & I can't imagine going through a surgery as big as this with youngin's runnin' around, lol!  We are surrounded by lots of love & support here in our military family, & I know they will bless us with so much help!  Just one more thing to do first I think... My family is coming out to visit soon, & I want to visit with my mom in person about this surgery... She has been a physical therapist for 37 years & has been very concerned about me going forward with the DFO as it is such a "rare" (though not for us here on this thread, lol!) procedure. 

Anyway, I'll keep y'all updated!  We'll probably contacts surgeon here on base in a couple weeks to give him the green light.  During my exploratory surgery in June, they harvested some cartilage that is now "asleep" on the east coast, & it takes about 6 weeks to grow in a Petri dish... So the surgery, if we go forward, will probably be in January I'm guessing.  Reading all of your posts helps to give me a peace about this decision! 

Thank you all soooo much, & I'll be praying for you guys, too!


(30 year old female)
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on October 22, 2013, 06:55:38 PM
My Goodness Young Lady!!!  If I ever had any "feel sorry for myself" moments - you would certainly cure them!!  6 surgeries on your right knee.  I have had 2 and I am dreading this third tremendously.  I don't have much in the way of knee pain - but my right ankle and ball of my foot are very painful and make it hard to walk.  That, coupled with the fact that I will turn 60 in March have encouraged me to get this situation behind me.  I am praying that God will be with me and that I will recover, heal and be able to take my grand daughter to Disneyland in the spring.

But my thoughts and prayers will be with you.  I know it is scary - but if you are going to be active - you don't have much choice.  God will be with you dear.  Your faith rings loud and clear in you talk.  Good for you!!!  He takes care of those that believe in Him and His Son.

Warmest regards,
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: LHall on November 10, 2013, 08:47:58 PM
Lee Tipton, just wondering how your surgery went??
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: chereb on November 14, 2013, 06:38:17 PM
Hi Lee, im touched you asked after me. Im doing ok replied on the update thread. Recovering well from my TKR and praying that this works after the DFO's went so wrong. Still in pain post surgery but it is getting less. I will update properly once i know how its turning out. Hope you are keeping well.
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Lee Tipton on November 26, 2013, 02:03:34 AM
Dear LHall,

I am doing quite well - thank you so much for asking.  I had surgery on 11/12/13, came home that Friday.  I have been being a good patient, doing what they say and staying down.  I sleep a great deal because of the pain meds but now I am starting to cut back some.  I iced the first 10 days - but the swelling is really subsiding now so i don't ice so much.  the worst thing is the non weight bearing and that is for another 4 weeks.  I have a diary in the less than 50 diary section titled Let the healing begin!.

Hope all is well with you.
Lee Tipton
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: Trentbrowne on December 15, 2013, 12:00:56 PM
Hello everyone my name is Trent im live in Australia im 27 and I've had knee problems all my life I have just been told after an MRI that I need DFO in both legs and have tissue tears im both knees severe arthritis behind both knee caps and a loose fragment in my right knee .At this point im very scared and can't get any sleep thinking why me and worried bout my first surgery like will I wake up and stuff i knew that it was coming but now it's been sorted out what I'm having im freaking out. I have 2 young kids that my partner is stay at home mum. Im trying to work out how do am I going to afford to take 3 -6 months off work omg thats going to be so hard .thanks for listening to me
Title: Re: Distal Femoral Osteotomy - Pre & Post-Op Diary
Post by: slightfield on April 15, 2017, 06:44:46 PM
I am having the exact same procedure in 2 weeks I am a 34 yr old female very active. Any chance we can talk more?